预防手术部位感染最新指南营养支持及相关措施解读

Latest guidelines for the prevention of surgical site infection(SSI): Comparative analysis and interpretations of nutritional support and the related measures

手术部位感染(SSI)是外科最常见的术后并发症,涉及医疗质量和医疗安全。手术难度和复杂程度的提高,同时微创外科、加速康复外科的快速发展等均对SSI预防提出了新的挑战。尽管国内外提出多个针对手术部位感染预防的指南,但其发生率并无明显变化。关于预防SSI,特别是相关措施如加强围手术期营养支持、强化血糖控制、术前肠道准备、术中术后液体治疗量和控制超重肥胖等环节应用,均有指南推荐或实施方案,但循证医学证据级别和具体内容不同。SSI的预防应从各个相关角度着手,引起社会及医院各方面的重视,针对性制定并推广规范化的诊治措施,并设法提高指南意见在医护人员及病人中的依从性。

Surgical site infection（SSI） is one of the most common postoperative complications,related to medical quality and medical safety. The difficulty and complexity of the operation,and the rapid development of minimally invasive surgery and enhanced recovery after surgery（ERAS） have brought new challenges to SSI prevention. Although there are a number of guidelines for prevention of surgical site infection,the incidence had no significant change. At present,guidelines about prevention of SSI focusing on the implementation of related nutritional program such as strengthening the perioperative nutritional support,intensive glycemic control,preoperative bowel preparation,the amount of intraoperative and postoperative fluid therapy and control of overweight and obesity have been recommended,but the evidence level and contents are different. More attention should be paid on the prevention of all related aspects of SSI by society and the hospital,developing and constituting formulation and criterion,and trying to improve compliance to the guidelines in the medical staff and patients.