新生儿开腹手术后切口感染的影响因素分析

Influence factors of incision infection in newborns after laparotomy

目的新生儿开腹手术后切口感染的影响因素分析。方法选取华中科技大学同济医学院附属武汉儿童医院行开腹手术的新生儿317例并分为感染组及非感染组,分析感染组病原菌类型、分布,单因素分析两组的临床资料及炎症因子,采用Logistic分析寻找引发炎症反应的影响因素。结果 317例患儿中共有31例发生切口感染,感染率为9.78%;共分离27株病原菌,其中革兰阴性菌15株(55.56%),革兰阴性菌12株(44.44%)。感染组肿瘤坏死因子-α(TNF-α)水平为(1.86±0.23) ng/ml、白细胞介素-6(IL-6)为(8.93±1.41) pg/ml、C-反应蛋白(CRP)为(38.48±17.34) mg/L、降钙素原(PCT)为(14.52±6.73)μg/L、WBC为(18.27±7.58)×10~9/L,均高于非感染组;新生儿感染与胎龄、出生体质量、手术时间、切口长度、母乳喂养及抗菌药物预防使用情况有关(P<0.05);Logistic分析显示:早产、手术时间过长及未预防使用抗菌药物是引发感染后炎症反应的独立影响因素。结论新生儿开腹手术后易发生切口感染,早产、手术时间过长及未预防使用抗菌药物为影响感染后炎症反应的独立影响因素,临床可通过监控以上因素,降低切口感染的发生概率。

OBJECTIVE To analyze the related risk factors of inflammatory response after laparotomy in newborns. METHODS A total of 317 newborns undergoing open abdominal surgery were divided into the infected group and non-infected group. The types and distribution of pathogenic bacteria in the infection group were analyzed. The clinical data and inflammatory factors in the two groups were analyzed by univariate analysis, and the risk factors of inflammatory response were found by logistic analysis. RESULTS There were 31 cases of incision infection in 317 cases, and the infection rate was 9.78%. A total of 27 pathogenic bacteria were isolated, of which 15(55.56%) were Gram-negative(G-) and 12(44.44%) were Gram-negative(G+). The level of TNF-α in infection group was(1.86±0.23) ng/ml, IL-6 was(8.93±1.41) pg/ml, CRP level was(38.48±17.34) mg/L, PCT was(14.52±6.73) g/L,WBC was(18.27 ±7.58) × 10~9 L, which was significantly higher than that in the non-infected group. The neonatal infection had correlation with gestational age, birth weight、the time of operation, length of incision, breast-feeding and antimicrobial prophylaxis(P<0.05). The results of further logistic analysis showed that premature delivery, prolonged operation time and non-use of antibiotic prophylaxis were independent risk factors for inflammatory reaction after infection. CONCLUSION Incision infection is easy to occur in newborns after laparotomy. Premature delivery, long operation time and non-use of antibiotic prophylaxis were independent risk factors for post-infection inflammatory response. Clinical monitoring of these factors can reduce the probability of incision infection.