子宫肌瘤患者并发术后感染的影响因素分析

Analysis of the influencing factors of postoperative infection in patients with uterine fibroids and the effect of nursing intervention on postoperative infection

目的探析子宫肌瘤患者并发术后感染的影响因素及护理干预对术后感染的作用。方法选取360例子宫肌瘤患者为本次研究对象,按照数字表抽取法进行分组,分为研究组与对照组。调取患者电子病例资料,对比术后感染组与未感染组患者的临床资料,分析并发术后感染的相关影响因素。对疑似感染患者采集标本,进行病原菌培养分离,采用全自动微生物鉴定系统进行病原菌鉴定。术后4 d,随机选取29例术后未并发感染患者,对比未并发感染与并发感染两组患者的血清白细胞介素-6(Inter leukin-6,IL-6)、C-反应蛋白(C reactive protein,CRP),分析血清IL-6、CRP水平对术后并发感染的预测价值。对照组患者进行常规手术护理,研究组患者在常规手术护理基础上给予护理干预,对比两组患者术后感染率、术后离床活动时间与肠鸣音恢复时间。结果360例子宫肌瘤患者中,术后感染率为8.06%(29/360)。研究组患者术后感染率为3.89%(7/180),对照患者术后感染率为12.22%(22/180),两组患者感染率差异有统计学意义(P<0.05)。共检出病原菌32株,革兰阴性菌20株,革兰阳性菌11株,真菌1株。革兰阴性菌中,主要为大肠埃希菌。革兰阳性菌中,主要为金黄色葡萄球菌。1株真菌为白色假丝酵母菌。对比感染组与未感染组患者临床资料进行单因素分析,子宫肌瘤直径、贫血、既往生殖道感染史、术前阴道检查次数、手术时间、术中出血量、术后出院时间差异均有统计学意义(P<0.05)。进一步进行二元Logistic多因素分析发现,贫血、具有既往生殖道感染史、术前阴道检查次数>2次、手术时间>120 min、术中出血量>200 mL、术后住院时间>7 d,是子宫肌瘤患者术后合并感染的独立危险因素(P<0.05)。对比29例子宫肌瘤患者术后并发感染与29例未合并感染患者术后4 d血清IL-6、CRP水平,感染组患者显著高于未感染组患者,差异有统计学意义(P<0.05)。采用ROC曲线评估诊断价值,术后4 d IL-6水平的曲线下面积(AUC)为0.987(95%CI:0.966~1.000),术后4 d CRP水平的曲线下面积(AUC)为0.954(95%CI:0.908~1.000)。对比研究组7例术后合并感染患者与对照组22例术后合并感染患者的离床活动时间与肠鸣音恢复时间,研究组患者离床活动时间为(31.29±9.16)h,肠鸣音恢复时间为(28.86±8.53)h,对照组患者离床活动时间为(46.27±10.08)h,肠鸣音恢复时间为(51.55±16.84)h,差异有统计学意义(P<0.05)。结论子宫肌瘤术后并发感染患者,病原菌主要为革兰阴性菌。贫血、具有既往生殖道感染史、术前阴道检查次数多、术中出血量大,手术时间、术后住院时间长是术后并发感染的独立危险因素。对患者进行护理干预措施,可以有效降低术后感染率,有助于患者早日恢复,提高临床治疗效果。

Objective The influencing factors of postoperative infection in patients with uterine fibroids and the effect of nursing intervention on postoperative infection were explored.Methods 360 patients with uterine fibroids admitted to our hospital were selected as the subjects of this study,and were divided into a study group and a control group by a digital table extraction method.Electronic case data of patients were retrieved to compare clinical data of postoperative infected and uninfected patients,and analyze the relevant influencing factors of postoperative infection.The samples from suspected infected patients were collected for pathogen cultivation and isolation,and pathogen were identified by a fully automated microbial identification system.Four days after surgery,29 patients without concurrent infection were randomly selected to compare the serum levels of interleukin-6(IL-6)and C-reactive protein(CRP)between the two groups of patients without concurrent infection and those with concurrent infection.The predictive value of serum IL-6 and CRP levels for postoperative concurrent infection was analyzed.The control group received routine surgical care,while the study group received nursing interventions on the basis of routine surgical care.The postoperative infection rate,postoperative ambulatory activity time,and bowel sound recovery time of the two groups of patients were compared.Results Among 360 patients with uterine fibroids,the postoperative infection rate was 8.06%(29/360).The postoperative infection rate of the study group patients was 3.89%(7/180),while the control group patients had a postoperative infection rate of 12.22%(22/180).The difference in postoperative infection rates between the two groups was statistically significant(P<0.05).A total of 32 pathogenic bacteria were detected,including 20 Gram negative bacteria,11 Gram positive bacteria,and 1 fungus.The main Gram negative bacteria were Escherichia coli.The main Gram positive bacteria were Staphylococcus aureus.One fungus was Candida albicans.Single factor analysis was conducted to compare the clinical data of patients in the infected and uninfected groups.The differences in uterine fibroid diameter,anemia,history of previous genital infections,preoperative vaginal examination frequency,surgical time,intraoperative bleeding volume,and postoperative discharge time were statistically significant(P<0.05).Further binary logistic multivariate analysis revealed that anemia,a history of previous genital infections,more than 2 preoperative vaginal examinations,surgery time>120 minutes,intraoperative bleeding>200 mL,and postoperative hospital stay>7 days were independent risk factors for postoperative co infection in patients with uterine fibroids(P<0.05).Comparing the serum IL-6 and CRP levels of 29 patients with postoperative infection of uterine fibroids and 29 patients without concurrent infection on the 4th day after surgery,the infected group was significantly higher than the uninfected group,and the difference was statistically significant(P<0.05).The diagnostic value was evaluated by the ROC curve.The area under the curve(AUC)of IL-6 levels was 0.987(95%CI:0.966-1.000)at 4 days after surgery,and the area under the curve(AUC)of CRP levels was 0.954(95%CI:0.908-1.000)at 4 days after surgery.A comparative study was conducted on the time of out of bed activity and bowel sound recovery between 7 patients with postoperative co infection in the study group and 22 patients with postoperative co infection in the control group.The time of out of bed activity in the study group was(31.29±9.16)hours,and the recovery time of bowel sound was(28.86±8.53)hours.The time of out of bed activity in the control group was(46.27±10.08)hours,and the recovery time of bowel sound was(51.55±16.84)hours,with statistically significant differences(P<0.05).Conclusion Patients with postoperative infection of uterine fibroids were mainly caused by Gram negative bacteria.The anemia,a history of previous genital tract infections,frequent preoperative vaginal examinations,large intraoperative bleeding,and long postoperative hospital stay were independent risk factors for postoperative infection.Nursing interventions for patients can effectively reduce postoperative infection rates,help patients recover early,and improve clinical treatment effectiveness.