胃肠道穿孔手术切口感染相关因素分析

Risk factors of surgical incision infection in patients with gastrointestinal perforation

回顾性分析2014年7月至2017年7月绍兴嵊州市人民医院288例胃肠道穿孔行手术治疗患者的临床资料,其中112例(38.9%)术后合并切口感染。单因素分析显示,胃肠道穿孔术后感染发生与术前血浆低白蛋白(≤30 g/L)、高BMI>24.0(kg/m^2)、腹痛时间长(>24 h)、术中延长切口、术前合并休克、术中肠造口、术前未使用抗生素以及手术时间长(>2 h)相关(均P<0.05),与年龄、性别、术前血红蛋白(≤90 g/L)、合并糖尿病以及切口长度等无关(均P>0.05)。logistic多因素回归分析显示,高BMI(OR=1.61,P=0.01)、穿孔位置(OR=5.60,P<0.01)、术中延长切口(OR=3.94,P<0.01)以及手术时间长(>2 h)(OR=1.04,P=0.02)是胃肠道穿孔术后切口感染的独立相关因素(均P<0.05)。提示胃肠道穿孔手术术后发生切口感染的概率增加,术前要做好充分的准备,积极治疗合并症,术中避免延长切口与手术时间,对预防切口感染有意义。

The clinical data of 288 patients with gastrointestinal perforation undergoing surgical treatment from Jul 2014 to Jul 2017 were retrospectively analyzed, among whom the surgical incision infection occurred in 112 patients(38.9%). The risk factors of the incision infections were examined with logistic regression analysis. The univariate analysis showed that preoperative albumin level (≤30 g/L), body mass index (>24.0 kg/m^2), duration of abdominal pain(>24 h), extension of incision, preoperative shock, colostomy, preoperative antibiotic use and the operation time were associated with incision infections(P<0.05), while the gender, age, preoperative hemoglobin level, diabetes, incision length were not associated with the incision infections(P>0.05). The multivariate logistic regression analysis showed that the body mass index(OR=1.61, P<0.01), gastrointestinal perforation site(colon and rectum, OR=5.60, P<0.01), extension of incision (OR=3.94,P<0.01) and operation time(OR=1.04,P=0.02)were independent risk factors of theincision infection. The results suggest that the full preoperative preparation, intensive treatment of underlying diseases, avoiding incision extension and shortening operation time may be able to reduce the surgical incision infections for patients with the gastrointestinal perforation.