宫腔镜术后盆腔感染的发生及影响因素

Occurrence and influencing factors of pelvic infection after hysteroscopy

目的:探讨宫腔镜术后盆腔感染的发生及影响因素。方法:回顾性收集本院2016年4月30日-2019年4月30日行宫腔镜手术治疗患者1340例临床资料,分析术后盆腔感染的病原菌分布及感染影响因素。结果:1340例中盆腔感染70例(5.2%),感染以革兰阳性杆菌感染为主(59.4%),革兰阴性杆菌占40.6%,未见真菌感染。盆腔感染组宫腔手术史、术中出血≥200ml、麻醉时间≥1h、器械进出宫腔≥4次、术前合并贫血和合并糖尿病比例高于未感染组,术前使用抗生素比例低于未感染组(均P>0.05)。logistic多因素分析显示,术中出血、麻醉时间、器械进出宫腔次数、术前合并贫血和合并糖尿病是宫腔镜手术后盆腔感染的独立危险因素,术前预防性使用抗生素是术后盆腔感染的独立保护因素(均P<0.05)。结论:术中出血≥200ml、麻醉时间≥1h、器械进出宫腔≥4次、术前贫血及合并糖尿病患者发生盆腔感染几率增加,术前预防性使用抗生素可降低盆腔感染发生。

Objective:To investigate the occurrence and influencing factors of pelvic infection after hysteroscopy.Methods:The clinical data of 1340 patients undergone hysteroscopic surgery from April 30,2016 to April 30,2019 were analyzed retrospectively.The distribution of pathogenic bacteria and influencing factors of postoperative pelvic infection were analyzed.Results:Among the 1340 patients,70(5.2%)patients had postoperative pelvic infection,which included 59.4%patients with Gram-positive bacillus infection and 40.6%patients with Gram-negative bacillus.No any patients with fungal infection were found in these patients with postoperative pelvic infection.The history of uterine cavity surgery,intraoperative bleeding≥200ml,anesthesia time≥1h,instruments entering and exiting the uterine cavity≥4 times of patients with postoperative pelvic infection were significant higher than those patients without postoperative pelvic infection(all P>0.05).Logistic multivariate analysis showed that intraoperative bleeding,anesthesia time,number of devices entering and exiting the uterine cavity,preoperative complications with anemia and diabetes were independent risk factors for pelvic infection after hysteroscopy.The prophylactic antibiotic used before surgery was independent protective factor of postoperative pelvic infection(all P<0.05).Conclusion:Patients with intraoperative hemorrhage≥200ml,anesthesia time≥1h,instruments entering and exiting the uterine cavity≥4 times,preoperative anemia and diabetics can increase the incidence of pelvic infection.Preoperative prophylactic antibiotics used can reduce the incidence of pelvic infection.