剖宫产手术切口感染的危险因素分析

Analysis on risk factors of caesarean section wound infections

目的调查剖宫产手术切口感染的相关危险因素,并探寻有效的预防对策。方法回顾性分析1995年1月-2013年1月收治的剖宫产术后切口感染产妇40例,将其作为观察组,再选取同期剖宫产术后切口无感染的40例产妇作为对照组,对比两组产妇的临床资料,调查切口感染的危险因素。结果单因素分析结果显示观察组产妇体质量指数为(28.78±2.32)kg/m2,腹部脂肪厚度为(3.17±0.43)cm,产科干预次数为(3.30±0.7)次,白细胞总数为(8.89±0.34)×109/L,手术时间为(1.24±0.21)h,而对照组分别为(26.34±1.68)kg/m 2、(2.13±0.35)cm、(2.1±0.5)次、(5.86±0.30)×109/L、(0.84±0.15)h,观察组均明显高于对照组;而观察组主刀及医师工龄为(8.76±2.34)年,较对照组(12.65±5.43)年短,差异有统计学意义(P<0.05);观察组切口感染产妇经抗菌药物预防治疗后,均痊愈出院。结论剖宫产术后切口较易感染,感染的主要危险因素有孕妇体质量指数、腹部脂肪厚度、实施产科干预、手术持续时间、白细胞总数、主刀及医师工龄等,通过控制产妇的体质量指数、避免不必要的阴道检查、术前评估产妇基本情况如腹部脂肪厚度及白细胞总数、缩短手术时间及抗菌药物预防等,有利于减少术后切口感染的发生。

OBJECTIVE To investigate the relative risks of infections of caesarean operation incision, and to explore effective prevention measures. METHODS A total of 40 puerpera were selected who hospitalized in our hospital during Jan. 1995 and January, 2013 and whose incision of caesarean operation was infected as the observation group. They were retrospectively analyzed. Then another 40 puerpera were chosen whose incision of caesarean operation was not infected as the control grouP. The clinical data in two groups were compared and the risks of infected incision were investigated. RESULTS Univariate analysis showed that maternal MBI in observation group was （28.78±2.32） kg/m2, abdominal fat thickness （3.17 ± 0.43） cm, the number of obstetric interventions （3.30±0.7） times, the total count of white blood cells （8.89±0.34） × 10^9/L, operative time （1.24±0.21） h, compared with （26.34±1.68） Kg/m^2 , （2.13-t-0.35） cm, （2.1±0. 5） times, （5.86±0.30） ×10^9/L, （0. 84±0.15） h in the control group. The observation group had significantly higher values of these measurements. In the observation group working years of surgeons and doctors was （8. 76±2. 34） years, significantly shorter compared with the control group （12.65 ± 5.43） years （P^0.05）. All incision-infected patients in the maternal observation group were cured and discharged after antibiotic prophylaxis treatment. CONCLUSIONS The incision of caesarean operation is easy to be infected. The main infected risks are the index of maternal weight, the thickness of abdominal fat, obstetric intervention, the time of the operation, the total count of white blood cell, the seniority of the main operator, etc. Controlling the MBI of puerpera, avoiding unnecessary vagina examination, assessing the basic situation of puerpera before the operation such as the thickness of abdominal fat as well as the total count of white blood cell, shorting the operation time as well as antibiotic prophylaxis are helpful for reducing incision infections after operation.