妇科开腹手术切口感染危险因素与防治对策

Risk factors and prevention and treatment of incision infection in gynecological laparotomy

目的妇产科手术多以腹部切口为主,因其属于Ⅱ类切口,故存在一定的术后感染概率。本研究分析妇科开腹手术术后切口感染危险因素,并探讨其应对措施。方法选择2016-08-01-2018-11-30三门峡市湖滨区妇幼保健院收治的子宫肌瘤行开腹手术治疗者为研究对象,选择发生切口感染的50例患者为观察组,未发生切口感染的50例患者为对照组。分析开腹子宫切除术腹部切口感染影响因素的相关危险因素。结果单因素分析结果显示,术前贫血(OR=5.228,95%CI为2.005~13.632,P=0.001)、切口长度>10cm(OR=5.613,95%CI为2.165~14.550,P<0.001)、术中输血(OR=1.156,95%CI为1.539~4.478,P=0.009)、糖尿病(OR=4.802,95%CI为1.629~11.474,P=0.003)和术前未备皮(OR=8.926,95%CI为3.560~22.382,P<0.001)为开腹子宫切除术腹部切口感染的相关危险因素。多因素Logistic分析结果显示,术前贫血(OR=14.541,95%CI为1.195~17.697,P=0.036)、合并糖尿病(OR=5.985,95%CI为1.381~21.098,P=0.017)和手术时间>3h(OR=5.836,95%CI为1.392~24.501,P=0.016)为开腹子宫切除术腹部切口感染的独立危险因素。结论针对术前贫血、合并糖尿病及手术时间>3h者应引起临床重视,避免切口感染的发生。

OBJECTIVE Abdominal incision is the main surgical procedure in gynecology and obstetrics.Because it belongs to typeⅡincision,there is a certain probability of postoperative infection.This study analyzes the risk factors of incision infection after gynecological laparotomy and explores its countermeasures.METHODS The patients with uterine leiomyoma treated with open surgery from August 1,2016 to November 30,2018 in Hubin District Maternal and Child Health Hospital of Sanmenxia City of Henan Province were selected as the research object.50 patients with incision infection were selected as the observation group,and 50 patients without incision infection were selected as the control group.The risk factors of abdominal incision infection after open hysterectomy were analyzed.RESULTS Univariate analysis shows preoperative anemia(OR=5.228,95%CI:2.005-13.632,P=0.001),incision length >10 cm(OR=5.613,95%CI:2.165-14.550,P<0.001),intraoperative blood transfusion(OR= 1.156,95%CI:1.539-4.478,P=0.009),diabetes(OR=4.802,95%CI:1.629-11.474,P=0.003)and without preoperative skin preparation(OR=8.926,95%CI:3.560-22.382,P<0.001)were risk factors for abdominal incision infection in open hysterectomy.Multiple logistic regression analysis preoperative anemia(OR=14.541,95%CI:1.195-17.697,P=0.036),diabetes(OR=5.985,95%CI:1.381-21.098,P=0.017)and operative time>3 h(OR=5.836,95%CI:1.392-24.501,P=0.016)were independent risk factors for abdominal incision infection in open hysterectomy.CONCLUSION For preoperative anemia,diabetes mellitus and operative time>3 h,should be paid to avoid the occurrence of wound infection.