剖宫产术后切口感染相关因素分析及甲硝唑液冲洗对其预防效果

Risk factors of incision infection after cesarean section and the preventive effect of metronidazole solution

目的了解剖宫产术后产妇切口感染的相关因素,并分析利用甲硝唑液冲洗对于切口感染的预防效果。方法选择2013年1月-2015年4月于医院行剖宫产术的产妇1860例为研究对象,将术后切口发生感染患者156例依据治疗方式又分为感染1组和感染2组,各78例。感染1组的产妇剖宫产术后立即用0.5%的甲硝唑溶液冲洗产妇的宫腔、腹腔及产妇腹壁的切口。感染2组的患者则利用0.9%的生理盐水进行冲洗,观察两组术后切口感染率及切口一期愈合率情况,并对术后感染相关因素进行分析。结果 1860例行剖宫产术的产妇共有156例发生术后切口感染,感染率为8.39%;共培养分离病原菌189株,其中革兰阴性菌113株占59.79%,以大肠埃希菌为主;革兰阳性菌76株占40.21%,以肠球菌属为主;体重指数、胎膜早破、羊水污染、合并基础疾病、侵入性操作及术中出血量是导致剖宫产术后切口感染的相关因素(P<0.05);感染1组一期愈合率为93.59%(73/78)高于感染2组83.33%(65/78)(P<0.001)。结论严格相关无菌操作、积极治疗相关基础疾病、控制手术时间和术中出血量,且给予剖宫产的产妇利用甲硝唑液冲洗在降低术后感染率和提高产妇切口愈合上效果较好。

OBJECTIVE To understand the related factors of incision infection in postpartum women after cesarean section,and analyze the preventive effect of flushing with metronidazole on incision infection.METHODS A total of 1860 maternal women who underwent cesarean section in hospital from Jan.2013 to Apr.2015 were selected as the study subjects.The 156 cases of patients with postoperative incision infection were divided into infection group1 and infection group 2 according to treatment methods,with 78 cases in each group.The uterine cavity,abdominal cavity and maternal abdominal incision of infection group 1 were immediately flushed with 0.5% metronidazole solution,and the infection group 2 was flushed with 0.9% normal saline.The incision infection rate and the firstphase healing rate of the incisions were observed in both groups,and the related factors of postoperative infection were analyzed.RESULTS A total of 156 women who underwent caesarean section had postoperative incision infection with the infection rate of 8.39%.There were 189 strains of pathogenic bacteria isolated from the cohort,of which 113 strains were gram-negative bacteria,accounting for 59.79%,mainly Escherichia coli,76 strains were gram-positive bacteria,accounting for 40.21%,mainly Enterococcus.The body mass index,premature rupture of membranes,amniotic fluid contamination,associated underlying diseases,related invasive procedures,and intraoperative blood loss were related factors associated with incision infection after cesarean section（P〈0.05）.The healing rate of infection group 1 was 93.59%（73/78）,which was significantly higher than 83.33% of infection group 2（65/78）（P〈0.001）.CONCLUSIONStrict aseptic technique,active treatment of related underlying diseases,control of operative time and intraoperative blood loss,and maternal cesarean section washing with metronidazole solution are effective in reducing postoperative infection rate and improving maternal incision healing.