肝胆外科患者手术部位感染病原菌分布与危险因素分析

Distribution of pathogens causing surgical site infections in patients of hepatobiliary surgery department and analysis of risk factors

目的探讨肝胆外科手术患者术后手术部位感染病原菌特点及相关危险因素,为降低肝胆外科患者术后感染提供依据。方法回顾性分析2010年1月-2014年12月医院肝胆外科收治的860例手术住院患者临床资料,分析其病原菌分布特点,单因素及多因素logistic回归分析术后患者发生手术部位感染的相关危险因素。结果 860例肝胆外科手术患者术后感染125例,感染率为14.53%;标本主要来源于胆汁、血液、腹腔引流液,共检出病原菌154株,其中革兰阴性菌、革兰阳性菌、真菌分别为97、50、7株,各占62.99%、32.47%、4.54%;单因素分析显示,手术时间>240min、术中出血量>800ml、切口类型、留置引流管、腹部手术史是肝胆外科术后患者发生感染的危险因素(P<0.05);多因素非条件logistic回归分析显示,手术时间、术中出血量、切口类型等因素是肝胆外科术后手术部位感染的独立危险因素(P<0.05)。结论需采取相应措施、缩短手术时间、减少术中出血量,以降低肝胆外科术后感染率。

OBJECTIVE To explore the distribution of pathogens causing the postoperative surgical site infections in the patients of hepatobiliary surgery department and analyze the related risk factors so as to reduce the incidence of the postoperative infections .METHODS The clinical data of 860 hospitalized patients who underwent the hepatobil‐iary surgery from Jan 2010 to Dec 2014 were retrospectively analyzed ,then the characteristics of distribution of pathogens were analyzed ,and the univariate analysis and multivariate logistic regression analysis were performed to observe the related risk factors for the surgical site infections .RESULTS Of 860 hepatobiliary surgery depart‐ment patients ,125 had postoperative infections with the infection rate of 14 .53% .The bile ,blood ,and peritoneal drainage fluid were the major specimen sources .A total of 154 strains of pathogens were isolated ,including 97 （62 .99% ） strains of gram‐negative bacteria ,50 （32 .47% ） strains of gram‐positive bacteria ,and 7 （4 .54% ） strains of fungi .The univariate analysis indicated that the risk factors for the postoperative infections in the hepa‐tobiliary department patients included the operation duration more than 240 min ,intraoperative blood loss volume more than 800ml ,types of incision ,drainage tube indwelling ,and history of abdominal surgery （P〈0 .05） .The non‐conditional multivariate logistic regression analysis showed that the operation duration ,intraoperative blood loss volume ,and types of incision were the independent risk factors for the postoperative surgical site infections in the patients of hepatobiliary surgery department （P〈 0 .05） .CONCLUSION It is necessary to take corresponding measures ,shorten the operation duration ,and reduce the intraoperative blood loss volume so as to reduce the inci‐dence of postoperative infections in the patients of hepatobiliary surgery department .