剖宫产后产褥感染的危险因素及护理策略

The risk factors and strategies of puerperal infection after cesarean section

目的探讨产褥感染的危险因素与护理策略。方法对浙江省慈溪市妇幼保健院在2011年1月～2012年12月收治的78例发生剖宫产术后产褥感染患者的临床资料进行分析，讨论导致产褥感染的危险因素，并对47例进行支原体培养，31例进行细菌培养，记录培养的阳性率，在临床上给予相应的抗生素治疗。结果支原体培养中32例呈阳性，阳性率为68．09％；细菌培养中17例呈阳性，阳性率为54．84％。产褥感染危险因素Logistic分析表明，第二产程剖宫产的OR值为9．23；阴道炎的OR、值为1．18；胎膜早破的OR值为1．81；妊娠糖尿病的OR值为6．23；产后出血的OR值为363，各危险因素的差异均有统计学意义（均P〈0．05），妊娠糖尿病、第二产程剖宫产、阴道炎、胎膜早破及产后出血是具有显著差异的危独立险因素。结论对于有产褥感染高危因素的产妇，需要在产前有针对性的治疗，同时采用合理的抗生素进行预防感染，加强预防措施。

Objective To investigate the risk factors and nursing strategies of puerperal infection. Methods The clinical data of 78 patients with puerperal infection occurred after cesarean section from January 2011 to December 2012 in the Maternity and Child Health Hospital of Cixi were analyzed and the risk factors leading to puerperal infection were dis- cussed. 47 cases were performed of mycoplasma and 31 cases of bacterial culture. The culture positive rate was recorded. The patients were given appropriate clinical antibiotic treatment. Results 32 cases were mycoplasma-positive, the posi- tive rate was 68.09%; bacterial cultures were positive in 17 eases, the positive rate was 54.84%. Logistic analysis of risk factors for puerperal infection showed that the OR of second stage caesarean was 9.23; OR value of vaginitis was 1.18; OR of PROM was 1.81; OR of gestational diabetes was 6.23; OR of postpartum hemorrhage was 3.63, the differ- ences in risk factors were significant （P 〈 0.05）. Gestational diabetes, the second stage caesarean section, vaginitis, pre- mature rupture of membranes and postpartum hemorrhage, all were independent risk factors with significant difference. Conclusion Those maternal who has risk factors of puerperal infection should get pertinent prenatal treatments and reasonable antibiotics to prevent infection. The strengthening preventive measures are necessary.