肝胆手术部位感染的临床特征及相关因素分析

Clinical characteristics and related factors of surgical site infections in patients undergoing hepatobiliary surgery

目的探讨肝胆手术部位感染的临床特征及其相关影响因素，为手术部位感染提供预防性指导意见。方法回顾性分析477例肝胆手术患者的临床资料，对手术部位感染率、感染部位及相关因素进行单因素和多因素分析，细菌培养和分离严格按《全国临床检验操作规程》进行，采用SPSS12．0软件对数据进行统计分析。结果477例肝胆手术患者中发生手术部位感染26例，感染率为5．45％，Ⅰ～Ⅳ类手术切口感染率分别为0．77％、3．85％、46．43％和100．00％，差异有统计学意义（P〈0．05）；感染部位分布为表浅切口感染23例、深部切口感染2例和器官腔隙感染1例，分别占88．46％、7．69％和3．85％；分离出革兰阴性菌19株占73．08％，革兰阳性菌7株占26．92％，其中以大肠埃希菌和金黄色葡萄球菌检出最多，分别占30．77％和23．08％；引流时间、术后并发症、手术时间、手术切口（Ⅱ～Ⅳ类）和开腹手术为手术部位感染的独立危险因素（P〈0．05）。结论肝胆外科患者手术部位感染与多种因素有关，应在评估患者病情后，采用腹腔镜手术，保持Ⅰ类手术切口，同时提高手术操作水平，加强术后并发症的护理，从而降低手术部位感染率。

OBJECTIVE To summarize the clinical features of surgical site infections, and to explore its related factors, in order to provide preventive guidelines for surgical site infections. METHODS The data of 477 cases treated by operation from hepatobiliary surgery department were collected. The incidence of surgical site infections and infectious sites were analyzed, and the related factors were analyzed by univariate and multivariate analysis,the bacterial culture and isolation were performed by strictly referring to the National Clinical Laboratory Proce- dures, and the statistical analysis of data was performed with the use of SPSS12.0 software. RESULTS Surgical site infections were found in 26 cases with the infection rate of 5. 45%. The incidences of Ⅰ , Ⅱ, Ⅲ and Ⅳ types of surgical incision were 0.77%, 3.85M, 46.43% and 100.00%, respectively, with a significant difference （P〈 0.05）. The infectious sites distributed in superficial incision in 23 cases.eep incision in 2 cases and organ lacunar in 1 case, accounted for 88.46%, 7.69M, 3.85%, respectively. A total of 19 strains of gram-negative bacteria and 7 strains of gram-positive bacteria were isolated, accounting for 73.08 % and 26.92 M, respectively. The two most common bacteria were Escherichia coli and Staphylococcus aureus, accounted for 30.77% and 23.08%, respectively. Drainage time, postoperative complications, surgical time, surgical incision （ Ⅱ ,Ⅲ and Ⅳ class） and open operation were the independent risk factors for surgical site infections （P 〈 0. 05）. CONCLUSION Surgical site infections are related to so many factors. Some measures should be taken according to those risk factors, such as using laparoscopic procedure, keeping Ⅰ class incision as far as possible, improving the level of operation, strengthening the nursing care of postoperative complications, in order to decrease the incidence of surgical site infections.