胰十二指肠切除术后感染的危险因素分析与防护对策

Risk factors analysis and protective countermeasures of infections after pancreatoduodenectomy

目的:探讨胰十二指肠切除术(PD)后感染的危险因素和护理预防。方法:回顾性分析2012年3月~2017年7月我院肝胆外科70例行PD术患者的临床资料,根据患者术后是否发生感染分为感染组38例和未感染组32例,观察感染组患者感染发生部位分布及细菌培养类型,收集患者的术前、术中及术后等一般资料并进行单因素分析,并将有统计学意义单因素进行多元logistic回归分析,探讨PD术后感染发生的危险因素。结果:感染组患者感染部位主要为腹腔、呼吸道、切口、泌尿系统和深静脉导管,引起患者感染的菌种主要为:大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、金黄色葡萄球菌。两组患者在术前TB、糖尿病、手术时间、术后白蛋白、术后胰瘘及术后胃排空延迟等方面比较,差异具有统计学意义(P<0.05),术前高TB、糖尿病、术后低白蛋白、术后胰瘘等为PD术后发生感染的独立危险因素(P<0.05)。结论:术前高胆红素血症、术前糖尿病、术后低白蛋白、术后胰瘘等是PD术后患者发生感染的独立危险因素,围术期根据感染发生的危险因素制定规范护理措施。

Objective: To explore the risk factors and nursing prevention of infections after pancreatoduodenectomy( PD). Methods: To make a retrospective analysis of clinical data of a total of 70 patients undergoing PD in the department of hepatobiliary surgery of our hospital from March 2012 to July 2017.The patients were divided into infected group of 38 cases and uninfected group of 32 cases in terms of postoperative infections. The distribution of infection sites and type of bacterial culture were observed and the preoperative,intraoperative and postoperative general data was collected for single factor analysis.In addition,a multivariate logistic regression analysis was made for the statistically significant single factors to explore the risk factors of infections after PD.Results: The infection sites of patients in the infected group mainly included abdominal cavity,respiratory tract,incision,urinary system and deep venous catheter. The main pathogens causing infections were Escherichia coli,Klebsiella pneumoniae,Pseudomonas aeruginosa,and Staphylococcus aureus. The preoperative TB,diabetes,operation time,postoperative albumin,postoperative pancreatic fistula and postoperative delayed gastric emptying were compared between the two groups,and the differences were statistically significant( P < 0. 05). The preoperative TB,diabetes,postoperative albumin and postoperative pancreatic fistula were the risk factors for infections after PD( P < 0. 05). Conclusion: The preoperative hyperbilirubinemia,preoperative diabetes,postoperative hypoalbuminemia and postoperative pancreatic fistula are independent risk factors for infection after PD. The standardized perioperative nursing measures should be formulated according to the risk factors for infection.