剖宫产手术部位感染目标性监测与分析

Surveillance and Analysis of Target of Surgical Site Infection in Cesarean Section

目的分析剖宫产手术部位感染发生情况及相关因素。方法采用目标性监测,2010年1月至2017年8月我院剖宫产患者共635例,发生手术部位感染35例(5.51%),作为观察组,选择与观察组同期在我院行剖宫产未发生手术部位感染的患者35例作为对照组。对胎膜早破、BMI>27 kg/m^2、血白蛋白<28 g、失血量>500 mL、手术时间>3 h情况进行分析,对手术切口感染患者进行病原菌检测。结果观察组胎膜早破、BMI>27kg/m^2、血白蛋白<28 g、失血量>500 mL、手术时间>3 h患者所占比均高于对照组(P<0.05)。共检出病原菌22株(62.86%),革兰阳性菌15株(68.18%),革兰阴性菌7株(31.82%)。结论胎膜早破、手术时间、BMI等多种因素均可增加剖宫产手术部位发生感染的几率,应对其进行积极干预,革兰阳性菌为剖宫产手术部位感染的主要致病菌,产科医生应重视围手术期病原学检查,合理用药,以使剖宫产感染率降低。

Objective to analyze the incidence and related factors of surgical site infection of cesarean section. Methods a total of 635 patients with cesarean section in our hospital were monitored from January 2010 to August 2017. 35 cases of surgical site infection(5.51%) were selected as the observation group, and 35 cases of patients who had no surgical site infection during cesarean section were selected as the control group. The condition of premature rupture of membranes, BMI > 27 kg/m^2, blood albumin < 28 g, blood loss > 500 mL, and operation time > 3 h were analyzed, and the pathogenic bacteria of the patients with surgical incision infection were detected. Results the proportion of premature rupture of membranes, BMI>27 kg/m^2, blood albumin <28 g, blood loss >500 mL and operation time >3 h patients was higher than that in control group(P< 0.05). 22 strains of pathogenic bacteria(62.86%), gram-positive bacteria 15 strains(68.18%), gram-negative bacteria 7 strains(31.82%) were detected. Conclusion multiple factors such as premature rupture of fetal membranes, operation time and BMI can increase the incidence of infection in the surgical site of cesarean section and should be actively intervened. Gram-positive bacteria are the main pathogenic bacteria in the surgical site of cesarean section. Obstetricians should pay attention to perioperative pathogenic examination and use reasonable drugs to reduce the infection rate of cesarean section.