剖宫产术后切口感染的危险因素分析

High risk factors of incision infections after cesarean section

目的探讨剖宫产术后发生切口感染的危险因素,制定对应的护理干预对策,以降低感染发生率。方法回顾性分析2009年2月-2013年2月收治的1 473例剖宫产产妇临床资料,模型筛选采用Stepwise法,采用非条件logistic回归分析危险因素。结果 1 473例剖宫产产妇术后共发生切口感染42例,感染率2.8%;单因素分析显示,切口感染的危险因素包括高龄>30岁、合并基础疾病(糖尿病)、体质量指数>25kg/m2、术中出血量>300ml、手术时间>60min、侵入性操作>5次,其感染率分别为6.6%、12.3%、7.3%、5.8%、5.8%、7.0%,差异有统计学意义(P<0.05);多因素分析显示,合并基础疾病的危险因素最大(P=0.009),其余危险因素依次为侵入性操作频繁(P=0.012)、手术时间较长(P=0.018)、体质量指数较高(P=0.021)等。结论剖宫产术后发生切口感染与多种因素关系密切,临床可采取针对性的护理干预对策预防感染,确保母婴安全。

OBJECTIVE To explore high risk factors of incision infections after cesarean section and formulate the corresponding nursing intervention countermeasures so as to reduce incidence of the infections. METHODS A retrospective analysis was perform for the clinical data of 1473 women who underwent cesarean section from Feb 2009 to Feb 2013, then the stepwise method was employed for model screening, and the unconditional logistic regression analysis was performed to analyze the risk factors. RESULTS Of totally 1 473 puerperas undergoing cesarean section, the incision infections occurred in 42 cases with the infection rate of 2. 8%. The univariate analysis showed that the risk factors of incision infection included the advaficed age （more than 30 years old）, complication of primary diseases（diabetes）, body mass index more than 25, amount of intraoperative bleeding more than 300 ml, operation duration more than 60 min, and the frequency of invasive operation more than 5 times, with the infections rates being 6.6% ,12.3% ,7.3% ,5.8% ,5.8% ,and 7.0K, respectively, the difference was significant （P〈0.05）; multivariate analysis indicated that the complication of underlying diseases was the greatest risk factor （P=0. 009）, followed by the frequent invasive operation （P=0. 012）, long operation duration （P=0. 018）, and high body mass index （P=0. 021）. CONCLUSIONS The incidence of the incision infections after cesarean section is closely related to a variety of factors, and the targeted nursing interventions should be taken to ensure the safety of maternal and infant.