产后发热原因及临床转归512例分析

Causes of postpartum fever and clinical outcomes of 512 cases

目的探讨产后发热的原因和临床治疗方法及预防措施。方法选择绍兴第二医院2011年1月1日至2013年12月31日512例产后发热患者的临床资料进行回顾性分析,并对结果进行分析。结果 2011至2013年分娩产妇共3 381例,其中发热512例,发热率为15.14%;发生医院感染31例,感染率为0.92%。3年来发热率及感染率均逐年下降,其中发热率差异有统计学意义(x^2=16.236,P<0.05),而感染率差异无统计学意义(x^2=1.503,P>0.05)。呼吸系统感染最多,占41.93%;手术切口次之,占22.58%。剖宫产中发热率(21.99%)明显高于阴道分娩(10.38%),两组比较差异有统计学意义(x^2=85.786,P<0.05);剖宫产中感染率(1.23%)明显高于阴道分娩(0.70%),两组比较差异无统计学意义(x^2=2.479,P>0.05)。结论产后发热是常见并发症,发热原因以非感染性因素为主;感染原因前3位是上呼吸道感染、剖宫产切口感染及泌尿道感染,采取针对病因的合理治疗能够取得较好的临床效果;加强病房管理及宣教工作,严格掌握剖宫产指征,遵循无菌操作,积极治疗合并症,可降低产后发热及医院感染的发生。

Objective To explore the causes, clinical treatment methods and preventive measures of postpartum fever.Methods From January 1, 2011 to December 31, 2013, the clinical data of 512 cases of postpartum fever in Shaoxing Second Hospital were retrospectively analyzed, and the results were analyzed.Results There were 3 381 cases of maternal childbirth from 2011 to 2013, including 512 cases of fever and the fever rate was 15.14%.Hospital infection occurred in 31 cases, and the infection rate was 0.92%.In 3 years the fever rate and infection rate declined year by year, and there was significant difference in fever rate （χ^2 =16.236,P〈0.05）.But the infection rate showed no statistical significance in different years （χ^2 =1.503,P 〉0.05）.Respiratory infection was most common, accounting for 41.93%, followed by operation incision, accounting for 22.58%.The fever rate of cesarean section （21.99%） was significantly higher than that of vaginal delivery （10.38%）, and there was significant difference between two groups （χ^2 =85.786,P〈0.05）.Infection rate of cesarean section （1.23%） was significantly higher than that of vaginal delivery （0.70%）, but the difference between two groups was not significant （χ^2 =2.479,P〉0.05）.Conclusion Postpartum fever is a common complication, and most of the causes of fever are non infectious factors.The first three causes of infection are upper respiratory tract infection, cesarean section incision infection and urinary tract infection.Reasonable etiology treatment for causes can achieve good clinical effect.The incidence of postpartum fever and hospital infection can be reduced by strengthening management and education, strictly grasping the indications for cesarean section, following aseptic operation, and active treatment of complications.