腹腔手术患者切口感染的相关因素调查分析

Related factors of incision infections in patients undergoing abdominal surgery

目的分析腹腔手术患者发生切口感染的高危因素,探讨相关预防措施,为临床治疗提供相关依据。方法回顾性分析2011年1月-2012年12月住院接受腹部外科手术治疗的3022例患者临床资料,采用自行设计的调查表调查患者年龄、手术名称、术前是否使用抗菌药物、切口类型、是否合并糖尿病及恶性肿瘤等资料,并提出相关预防措施,将发生感染的32例患者为观察组,随机选取同期腹部手术未发生感染32例患者为对照组。结果腹腔手术后切口感染32例,感染率为1.06%,年龄>60岁、肠道手术、Ⅲ类手术切口、术前未预防性使用抗菌药物、手术持续时间>2h、合并糖尿病及恶性肿瘤的患者更容易出现术后腹腔切口感染,观察组与对照组患者相比,两组差异有统计学意义(P<0.05);观察组患者手术持续时间为(149.42±19.32)min、空腹血糖为(11.21±4.20)mmol/L、糖化血红蛋白为(8.11±2.04)%,均明显高于对照组,两组间差异有统计学意义(P<0.05);在32例腹腔手术后切口感染患者中有19例培养出病原菌,共23株病原菌,绝大多数为院内常见耐药菌,检出大肠埃希菌、阴沟肠杆菌、金黄色葡萄球菌、表皮葡萄球菌、白色假丝酵母菌、变形菌属、铜绿假单胞菌,分别占30.44%、17.39%、17.39%、13.04%、13.04%、4.35%、4.35%。结论高龄、肠道手术、Ⅲ类手术切口、术前未预防性使用抗菌药物、手术持续时间>2h、合并糖尿病及恶性肿瘤等为腹腔手术后切口发生感染的高危因素,应合理预防性使用抗菌药物,最大限度地降低腹腔手术后切口感染的发生率。

OBJECTIVE To analyze the high risk factors of incision infections in patients undergoing abdominal surgery and explore corresponding prevention measures so as to guide the clinical treatment. METHODS The clinical data of 3022 cases of hospitalized patients who underwent abdominal surgery from Jan 2011 to Dec 2012 were retrospectively analyzed, the age of the patients, type of surgery, preoperative use of antibiotics, type of incision , and complication of diabetic mellitus or malignant tumor were surveyed by using self-designed questionnaires, the related prevention measures were put forward ; the 32 cases of patients with infections were set as the observation group, and 32 cases of patients who underwent the abdominal surgery and were not being infected were randomly selected as the control group. RESULTS The incidence rate of the incision infections after abdominal surgery was 1.06% （32 cases）. The patients with more than 60 years of age, undergoing intestinal surgery, type m surgical incision, preoperative antibiotics prophylaxis, operation duration more than 2 hours, com- plication of diabetes or malignant tumor were more prone to the postoperative abdominal incision infections, the difference between the observation group and the control group was statistically significant（P〈0.05）. The operation duration of the observation group was（149.42 ±19.32）min, the fasting blood-glucose level（11. 21±4. 20） mmol/L, the level of glycosylated hemoglobin（8.11 ± 2.04） %, all of which were significantly higher than those of the control group, the difference between the two groups was statistically significant （P〈0.05）. Among the 32 patients who underwent the abdominal surgery, totally 19 strains of pathogens were isolated from the patients with postoperative incision infections, most of the isolates were common species of drug resistant bacteria in the hospital, and the Escherichia coli , Enterobacter cloacae, Staphylococcus aureus , Staphylococcus epidermidis ,Candida albicans, Proteus and Pseudomrnonas aeruginosa were dominant among the pathogens isolated, accounting for 30. 44%, 17. 39%, 17. 39%, 13. 04%, 13. 04%, 4. 35%, and 4. 35%, respectively. CONCLUSION The advanced age, intestinal tract operation, type III surgical incision, without preoperative antibiotics prophylaxis, operation duration more than 2 hours, and complication of diabetes or malignant tumor are the high risk factors of the incision infections after abdominal surgery; it is necessary to strengthen the reasonable antibiotics prophylaxis so as to reduce the incidence of incision infections to the greatest extent.