26例先天性心脏病患者术后发热原因分析

Causes of fever in 26 patients after the surgery for congenital heart disease

摘要:

目的探讨先天性心脏病患者术后发热原因，提出相应的防控措施。方法选取2013年1—5月某院小儿外科先天性心脏病术后26例患者临床资料进行回顾性分析，并现场观摩手术及术后治疗护理过程，同时对环境进行卫生学监测。结果26例患者术后均有发热，其中21例患者发热原因为非感染性因素，占80.77%；5例（19.23%）患者为感染性因素（呼吸机相关性肺炎4例，Ⅰ类切口感染1例）。其中吸收热组患者 6例，异常发热组患者20例，两组患者年龄、侵入性操作（呼吸机、导尿管、胃管）使用时间比较，差异均有统计学意义（均P＜0.05），吸收热组患者年龄较大，侵入性操作时间短。26例患者细菌学送检率为76.92%（20例），共送检标本58份， 7份阳性（来自4例患者痰标本），其中铜绿假单胞菌5株（71.43%）。共采集环境标本52份，合格率为80.77%（42份）。结论先天性心脏病术后发热患者，以非感染性因素为主要原因，医护人员应加强无菌观念，规范各项医疗操作，减少术后发热。

Abstract:

ObjectiveTo explore causes of fever in patients after the surgery for congenital heart disease(CHD), and put forward corresponding prevention and control measures. MethodsClinical data of patients undergoing surgery for CHD in the department of pediatric surgery of a hospital between January  and May 2013 were analyzed retrospectively, the whole process of operation and postoperative nursing were observed, environmental hygiene monitoring was performed at the same time. Results26 patients all had fever after operation,  fever in 21 cases (80.77%) was caused by noninfectious factors, 5(19.23%）by infectious factors (ventilatorassociated pneumonia in 4 cases, type I incision infection in 1 case).  6 cases were absorption fever,20 were abnormal fever,  difference in patients’ age, duration of invasive manipulation (ventilator, urinary catheter, gastric tube) between two groups of patients were all statistically significant (all P<0.05), patients in the absorption fever group were with older age and short invasive manipulation time. Bacteriological detection rate in 26 patients was 76.92% (n=20), a total of 58 specimens were detected, 7 were positive(from sputum specimens of 4 patients), 5 isolates(71.43%) were  Pseudomonas aeruginosa. A total of 52 environmental specimens were collected for detection,  the qualified rate was 80.77% (n=42). ConclusionNoninfectious factors are the main causes of postoperative fever in patients with CHD, health care workers should enhance the awareness of sterilization, standardize all kinds of  medical manipulation, and reduce postoperative fever.