切口保护套预防开放性腹部手术后切口感染的临床效果

Clinical efficacy of circular wound edge protector in preventing surgical site infection following open abdominal surgery

目的：探讨切口保护套预防开放腹部手术后切口感染的有效性，分析腹部切口感染的相关危险因素，为预防开放性腹部手术部位感染提供科学依据。方法将2014年3月—2015年12月某院普通外科行开放性腹部手术的162例患者，随机分为干预组（术中使用一次性切口保护套）和对照组（常规应用无菌纱布垫对切口进行保护），比较两组患者住院时间、换药费用、切口感染情况，分析腹部切口感染的相关危险因素。结果干预组术后切口感染发病率为14．81％（12／81），低于对照组的34．57％（28／81）；干预组切口甲级愈合率为86．42％，高于对照组的66．67％，差异均有统计学意义（均 P ＜0．05）。干预组住院期间换药费用低于对照组[（305．5±176．7）元 vs （431．6±381．4）元]，差异有统计学意义（P ＝0．008）。多因素 logistic 回归分析提示，低蛋白血症（OR＝2．88，95％CI ：1．21～6．87）、BMI≥24（OR ＝3．11，95％CI ：1．12～8．66）及出血量≥400 mL（OR ＝3．98，95％CI ：1．36～11．64）是手术部位感染的独立危险因素，使用切口保护套是保护性因素（OR ＝0．24，95％CI ：0．09～0．59）。结论切口保护套有效降低了开放性腹部手术部位感染发病率。

Objective To explore the efficacy of circular wound edge protector（CWEP）in preventing surgical site infection （SSI）following open abdominal surgery,analyze the related risk factors for postoperative SSI,and provide scientific basis for preventing SSI following open abdominal surgery.Methods 162 patients who underwent open abdominal surgery in a hospital from March 2014 to December 2015 were randomly divided into intervention group （used CWEP during surgery）and control group （used sterile gauze pad to protect incision）.Length of hospital stay,cost of dressing change,and SSI between two groups were compared,risk factors for postoperative SSI were analyzed.Results Incidence of SSI in intervention group was lower than control group （14.81%[12/81]vs 34.57%[28/81],P 〈0.05）;grade-A incision healing rate of intervention group was higher than control group（86.42% vs 66.67%,P 〈0.05）.The cost of dressing change in intervention group was lower than control group（[305.5 ± 176.7]yuan vs [431.6 ± 381.4 ]yuan,P = 0.008 ）. Multivariate logistic regression analysis indicated that hypoproteinemia（OR,2.88[95%CI ,1.21-6.87]）,body mass index ≥24（OR,3.11[95%CI ,1.12-8.66]）,and blood loss≥400 mL（OR,3.98[95%CI ,1.36- 11.64]）were independent risk factors for postoperative SSI,while CWEP use was the protective factor（OR,0.24[95%CI ,0.09-0.59]）.Conclusion CWEP can effectively reduce the incidence of SSI following open abdominal surgery.