全国187所医院腹部手术术前皮肤准备现状调查

Preoperative skin preparation for abdominal surgery in 187 hospitals of China

目的了解我国医院腹部手术术前皮肤准备情况,并提出改进建议。方法 2016年4—5月选取全国187所二级及以上医院,采用问卷调查的方式,对医院腹部手术术前手术部位毛发去除方法、术野皮肤消毒方法和手术贴膜使用情况进行调查。结果共调查14个省份187所医院,其中三级医院108所,二级医院79所。87.70%的医院在腹部手术术前仍常规去除手术部位毛发,其中二级医院常规去除率(93.67%)高于三级医院(83.33%),差异有统计学意义(χ2=4.520,P=0.033)。85.98%的医院用刀片刮除的方式,少数医院选择化学脱毛(7.93%)或电动剪毛(23.78%)方式。大多数医院在病房(98.17%)备皮,98.17%的操作人员为病房护士,手术当日备皮占56.10%。86.63%的医院术野皮肤消毒使用碘伏,29.95%使用碘酒+乙醇,3.74%使用氯己定醇。92.51%的医院在术中使用皮肤/切口保护贴膜,其中74.57%的医院为有选择性的使用。结论我国大部分医院腹部手术术前仍常规去除手术部位毛发,且多数采用刀片刮除的方式,超过一半的医院在手术当日去除毛发。碘伏是主要的术野皮肤消毒方法,大多数医院使用手术贴膜,但使用的手术有限。

Objective To investigate the current status of preoperative skin preparation in abdominal surgery in China,and put forward suggestions for improvement.Methods From April to May,2016,187 secondary and above hospitals in China were selected,questionnaires were used to investigate the methods for hair removal,skin disinfection on operative field,and application of surgical adhesive drape in abdominal surgery.Results A total of187 hospitals in 14 provinces were investigated,of which 108 and 79 were tertiary and secondary hospitals respectively.87.70% of hospitals performed conventional preoperative hair removal in abdominal surgery,the percentage of conventional depilation in secondary hospitals was higher than tertiary hospitals（93.67% vs 83.33%,χ^2=4.520,P=0.033）.85.98% of hospitals selected blade-shaving,7.93% and 23.78% applied chemical depilation and electric depilation respectively.Most hospitals（98.17%）performed skin preparation in the wards,mainly byward nurses（98.17%）,and conducted on the day of surgery（56.10%）.86.63%,29.95%,and 3.74% of hospitals used iodophor,iodine plus alcohol,and chlorhexidine respectively for disinfecting skin on operative field.92.51% of hospitals used skin incision/surgical adhesive drape（74.57% used selectively）.Conclusion Most hospitals in China conventionally perform preoperative hair removal in abdominal surgery,and the primary method for depilation is blade-shaving,nearly half of the hospitals performed depilation on the day of surgery.Iodophor is the major skin antiseptic,surgical adhesive drape is widely used,but it is utilized in limited types of surgery.