妇科肿瘤患者术后盆腔感染情况调查、病原菌分布及其危险因素分析

Pelvic infection after gynecological tumor surgery,distribution of pathogenic bacteria and its risk factors

目的调查妇科肿瘤患者术后盆腔感染的情况以及病原菌分布,并探讨术后发生盆腔感染的危险因素。方法回顾性分析自2013年1月到2017年1月在东南大学附属中大医院接受妇科肿瘤手术治疗的384例患者的临床资料。统计妇科肿瘤术后盆腔感染的发生率及病原菌的分布情况。将发生盆腔感染的患者分为感染组,未发生盆腔感染的患者分为未感染组,对比两组的临床资料,并通过多因素Logistic回归分析,归纳妇科肿瘤患者术后发生盆腔感染的危险因素。结果术后发生盆腔感染41例,感染率为10.68%,培养出病原菌54株,其中革兰阳性菌14株,占25.93%,革兰阴性菌35株,占64.81%,真菌5株,占9.26%。感染组患者年龄>60岁的比例、手术持续时间>2h的比例、合并慢性基础疾病的比例、开放手术的比例、术前化疗的比例、术后留置引流管的比例和术后卧床时间>7d的比例均显著高于未感染组(均P<0.05);多因素Logistic回归分析结果显示,年龄大、手术持续时间长、合并慢性基础疾病、开放手术、术前化疗、术后留置引流管、术后卧床时间长均是妇科肿瘤患者术后盆腔感染的危险因素(均P<0.05)。结论妇科肿瘤患者术后较容易并发盆腔感染,病原菌主要为革兰阴性菌。多种因素可增加术后盆腔感染的风险,临床应加强防控措施,降低妇科肿瘤患者术后盆腔感染的发生率。

Objective To investigate the incidence of pelvic infection after gynecological tumor surgery,distribution of pathogenic bacteria and its risk factors.Methods The clinical data of three hundred and eightyfour patients underwent gynecological tumor surgery in our hospital from January 2013 to January 2017 were retrospectively analyzed for the incidence of pelvic infection after gynecological tumor surgery and the distribution of pathogenic bacteria,and compared between the patients with pelvic infection（infection group）and those without（non-infection group）.The risk factors of pelvic infection after gynecological tumor operation were analyzed with multiple factor logistic regression analysis.Results There were forty-one cases of pelvic infection after operation.The infection rate was 10.68%.Fifty-four strains of pathogenic bacteria were isolated,including fourteen strains（25.93%）of Gram-positive bacteria,thirty-five strains（64.81%）of Gram-negative bacteria,and five strains（9.26%）of fungi.The proportions of patients aged〉sixty,operation duration 〉2 hours,combined chronic diseases,open surgery,preoperative chemotherapy,postoperative indwelling drainage tube and postoperative bed days 〉7 in the infection group were significantly higher than those in non-infection group（Ps〈0.05）.Multivariate logistic regression analysis showed that age,operation duration,combined chronic diseases,open surgery,preoperative chemotherapy,postoperative indwelling drainage tube and postoperative bed days were the risk factors of pelvic infection after gynecological tumor surgery（P〈0.05）.Conclusion Pelvic infection often occurs after gynecologic tumor operation,and the main pathogens are Gram negative bacteria.A variety of factors can increase the risks of postoperative pelvic infection.Clinical prevention and control measures should be strengthened to reduce the incidence of postoperative pelvic infection in patients with gynecological tumors.