会阴侧切术切口感染的危险因素分析

Risk factors for incision infections after episiotomy

目的了解会阴侧切术(LE)切口感染的危险因素,为探讨有效的护理对策提供依据。方法采用回顾性调查方法,对2010年1月-2011年12月行LE的775例产妇相关临床资料进行分类统计,内容包括基础疾病、胎膜早破、产程、抗菌药物使用、住院时间、愈后等资料,切口感染率差异的比较采用χ2检验。结果两年共有27例发生切口感染,感染率为3.5%;其中2010、2011年的感染率分别为3.9%、3.1%(χ2=1.05,P>0.05);27例感染产妇均有典型的手术部位感染的临床特征;全部均有切口分泌物,其中25例为脓性分泌物,体温38~39.2℃,切口部位红、肿、热、痛明显,分泌物细菌培养有26例检出病原菌;产前有生殖道感染等基础疾病、胎膜早破、产程时间≥10h、住院时间≥4d、阴道操作次数≥4次、会阴侧切缝合技术欠熟练等是LE术后切口感染的主要危险因素。结论严格掌握LE适应证,对产妇原有疾病应积极治疗,减少阴道检查操作次数,加强规范化操作培训和术后护理等措施有助于降低LE切口感染发生率。

OBJECTIVE To understand the risk factors and nursing strategies of incision infections after lateral episiotomy （LE） so as to provide basis for the effective nursing countermeasures. METHODS The data of 775 cases of maternity who accepted LE from Jan 2010 to Dec 2011 were collected by retrospective method, which included other basic diseases, premature rupture of membrane, stage of labor, antibacterial drug use, length of hospital stay, and prognosis, then the variation of the incidence of incision infections was checked by chi-square test. RESULTS Twenty-seven cases of incision infections occured in two years, the total infection rate was 3.5 %. The infection rates in 2010 and 2011 were 3.9~ and 3.1 ~//00, respectively（z2 = 1.05,P^0.05）. All 27 infected cases had the typical clinical features such as incision secretion, and 25 of them were purulent secretion, their temperatures were from 38 ~C to 39.2 ~C, incision sites were red, swollen, heat and pain obviously, there were 26 cases cultured pathogenic bacteria; the risk factors of incision infections after episiotomy involved some underlying diseases like reproductive tract infections, premature rupture, stage of labor more than ten hours, hospitalization duration more than four days, vagina operation more than four times, and unskilled operator of episiotomy. CONCLUSION The following are some effective measures to reduce the incision infections, strict control of indication for episiotomy, positive treatment for underlying diseases, reduction of frequency of vaginal examination, enhancement of strndard operation, and postoperative nursing.