直结肠恶性肿瘤切除术手术部位感染的发生率及影响因素

The incidence and influence factors of surgical site infections in colorectal cancer patients

目的调查直结肠恶性肿瘤切除手术手术部位感染发生率,并探讨可能的影响因素。方法采取回顾性研究方法,随机抽取2003、2008、2013年进行直、结肠恶性肿瘤切除术患者的病历资料各100份,共300份,比较这3年手术部位感染发生率的情况。结果 2013年为手术当天备皮,全部使用普通手术贴膜,另外两年为术前一天备皮,未使用手术贴膜。3年病历资料显示,患者总住院时间及入院后至手术的时间差异均无统计学意义(P>0.05);2003、2008、2013年手术部位感染发生率分别为4%、4%和13%,术中预防用药合理率分别为38%、35%和69%,术后抗菌药物用药时间<72小时的比例分别为4%、1%和19%,这3个指标2013年明显高于2003及2008年(均P<0.05);手术持续时间分别为245、200和180min,2003年比2008、2013年手术持续时间长,差异均有统计学意义(P<0.05),2008与2013年比较,差异无统计学意义(P>0.05);术前预防用药时机合理率分别为7%、44%和93%,3年间差异均有统计学意义(P<0.05)。结论在直结肠恶性肿瘤切除手术患者,2013年手术部位感染率明显高于2003及2008年,普通手术贴膜使用者手术部位感染发生率明显高于未使用贴膜患者,手术部位感染可能与普通手术贴膜的使用有关。

Objective To investigate potential factors of surgical site infections in colorectal cancer patients in our hospital. Methods The clinical data of 300 colorectal cancer patients treated in the hospital in 2003,2008 and 2013 were retrospectively analyzed, and studied on the effect of common plastic adhesive drape in surgical site infections. Results In 2013 ,skin provision were done in the operations day and all patients were used common plastic adhesive drapes. In 2003 and 2008, skin provision was done before the operations day and all patients did not use plastic adhesive drapes. The total hospital time and the time from the first day in hospital to the operation day had not statistical difference. In 2003, 2008 and 2013, the rates of surgical site infections were 40%0, 4% and 13% The reasonable rates of antimicrobial agents during operations were 38%, 35% and 69%. The rates of the time of antimicrobial agents less than 72 hours after operations were 4%, 1% and 19%. The above three indexes in 2013 was higher than that in 2003 and 2008. The duration time of operation was 245, 200 and 180 minutes. The data in 2003 were higher than that in 2008 and 2013. There was not statistical difference in 2008 and 2013. The reasonable rates of antimicrobial agent occasion before operations were 7%/00, 44% and 93%. There was statistical difference between three years. Conclusion The rate of surgical site infections in colorectal cancer patients in 2013was higher than that in 2003 and 2008. The rate of surgical site infections using common plastic adhesive drapes was higher more than the patients of nonuse plastic adhesive drapes. The common plastic adhesive drape may be related to surgical site infection.