产妇经阴道分娩会阴侧切缝合术后感染的病原菌特点及危险因素分析

Pathogenic bacteria characteristics of perineal episiotomy and perineal vaginal delivery and analysis of risk factors

目的探讨会阴侧切产妇切口术后发生感染的病原菌分布及危险因素分析,为临床防治提供理论依据。方法选取2014年1 月- 2017年6月在本院产科顺产且会阴侧切缝合术的产妇1186 例,收集患者阴道侧切切口的分泌物,采用细菌自动分析仪对所培养细菌进行分离鉴定,对产妇的临床资料采用单因素和多因素Logistic回归分析,探讨影响其切口感染的危险因素并提出相关的干预措施。结果1 186 例会阴侧切产妇切口术后72例发生感染,发生率为6. 07%,共培养出78株病原菌,其中革兰阳性菌54株,占69.23%,革兰阴性菌20株,占25.64%,真菌感染4株,占5.13%。单因素和进一步Logistic回归分析显示,胎膜早破第二产程时间≥2 h、合并糖尿病分娩产程时间≥8 h、生殖道感染和切口长度≥3 cm是会阴侧切产妇切口术后发生感染的独立的危险因素(P<0.05)。结论会阴侧切产妇切口术后发生感染的病原菌以革兰阳性菌为主,针对相关危险因素临床应改进和完善控制方法,可以预防感染发生。

Objective To investigate the distribution of pathogens and their risk factors after episiotomy in patients with episiotony, so as to provide theoretical basis for clinical prevention and treatment. Methods 1186 maternal obstetrics and gynecological sutures were performed in our hospital from January 2014 to June 2017. The secretions from the vaginal incision were collected. The bacteria were separated and identified by automatic bacterial analyzer. Univariate and multivariate Logistic regression analysis were used to analyze the risk factors of incisional infection and to propose relevant interventions. Results In the 1 186 cases of perineal lateral incision, 72 cases of infection occurred, the incidence rate was 6. 07%,and 78 strains of pathogens were cultured. Among them, 54 were Gram-positive bacteria, accounting for 69.23%,20 cases were Gram-negative bacteria infection, accounting for 25. 64%,Fungi was observed in 4 cases, accounting for 5. 13%. Univariate and further Logistic regression analysis showed that premature rupture of membranes, the second stage of labor time≥2 h, with diabetes, labor delivery time of≥8 h, genital tract infection and incision length ≥3 cm were independent risk factors for episiotomy maternal incision infection (P<0. 05). Conclusion Gram-positive bacteria are the main pathogens causing infection after perineal incision in the perineal region. In order to prevent and reduce the incidence of infection, we should improve and perfect the control method according to the relevant risk factors.