不同手术治疗异位妊娠出血性休克孕妇感染的调查分析

Investigation of different surgical methods in the treatment of infections for pregnant women with ectopic pregnancy hemorrhagic shock

目的分析不同手术治疗异位妊娠出血性休克孕妇感染的调查,为降低感染率减少并发症提供参考依据。方法随机选取2013年6月-2015年6月收治300例手术治疗异位妊娠出血性休克孕妇患者,将其分为两组,采用腹腔镜手术患者150例为腹腔镜组,开腹手术患者150例为开腹组,根据异位妊娠位置、是否保留输卵管、异位妊娠的类型等决定手术方式,术中采集标本为开腹组患者进行菌群培养与鉴定及药敏试验,术后两组患者均给予切口换药,清洗外阴。结果腹腔镜组、开腹组泌尿系统感染率分别为0、4.00%;手术切口感染率分别为0与4.67%;总感染率分别为2.00%、18.67%,与开腹组相比,腹腔镜组泌尿系统感染率、手术切口感染率以及总感染率均显著降低;开腹组患者菌株总数为190株,其中大肠埃希菌、铜绿假单胞菌、阴沟肠杆菌构成比分别为36.84%、27.89%、10.00%;腹腔镜组患者菌株总数为131株,其中大肠埃希菌、铜绿假单胞菌、阴沟肠杆菌构成比分别为22.90%、16.79%、15.27%,与开腹组相比,腹腔镜组患者大肠埃希菌以及铜绿假单胞菌均显著降低;对大肠埃希菌、铜绿假单胞菌、阴沟肠杆菌进行药敏试验,均对氨苄西林/舒巴坦、亚胺培南高度敏感。结论腹腔镜组泌尿系统感染率、手术切口感染率和总感染率均显著低于开腹组,值得临床推广。

OBJECTIVE To investigate and analyze different surgical methods in the treatment of infections for pregnant women with ectopic pregnancy hemorrhagic shock,so as to provide reference for reducing infection rates and complications.METHODS A total of 300 cases of surgery treatment of pregnant patients with ectopic pregnancy hemorrhagic shock in our hospital from Jun.2013 to Jun.2015 were randomly chosen.They were divided into two groups,150 cases were taken with laparoscopic surgery,and 150 patients were taken with laparotomy surgery.The specific type of surgery was determined by the locations of ectopic pregnancy,whether retain the fallopian tubes,and the types of ectopic pregnancy.The specimens collected during the surgery were taken for bacteria culture,identification and susceptibility testing.The patients were taken for incision dressing every day and washed the vulva.RESULTS The infection rates of urinary system of laparoscopic group and laparotomy group were 0%and 4.00%,the surgical wound infection rates were 0 % and 4.67%,and the overall infection rates were 2.00%and 18.67%.Compared to the laparotomy group,the urinary system infection rate,surgical wound infection rate and the overall infection rate of laparoscopic group were significantly reduced.The total number of strains in laparotomy group were 190 cases,in which the constituent ratio of Escherichia coli,Pseudomonas aeruginosa,Enterobacter cloacae were 36.84%,27.89%,and 10.00%,respectively.The total number of strains in laparoscopic group were 131 cases,in which the constituent ratio of E.coli,P.aeruginosa,E.cloacae were 22.90%,16.79%,and 15.27%,respectively.Compared to laparotomy group,the E.coli and P.aeruginosas in laparoscopic group were significantly reduced.The susceptibility test results indicated that E.coli,P.aeruginosa,and E.cloacae were highly sensitive to ampicillin/sulbactam,and imipenem.CONCLUSION The urinary system infection rate,surgical wound infection rate and the overall infection rate in laparoscopic group are significantly lower than those of laparotomy group,and it is worthy of promotion.