妊娠期糖尿病孕妇分娩后会阴切口感染的危险因素及防控措施

Risk factors and prevention and control measures of perineal incision infection in pregnant women with gestational diabetes mellitus after delivery

目的探讨妊娠期糖尿病(Gestational diabetes mellitus,GDM)孕妇分娩后会阴切口感染的危险因素及防控措施。方法选择2015年1月至2020年1月于本院接受会阴侧切术行阴道分娩,且术后发生会阴切口感染的GDM孕妇60例作为观察组,选择同期于本院接受会阴侧切术行阴道分娩,术后未发生会阴切口感染的GDM孕妇60例作为对照组。分析观察组孕妇的病原菌分布情况,比较观察组与对照组的各项基线资料,并作多因素Logistic回归分析。结果60例会阴切口感染患者共检出病原菌102株,其中以铜绿假单胞菌、大肠埃希菌、鲍氏不动杆菌、金黄色葡萄球菌、表皮葡萄球菌为主,占比分别为28.43%、19.61%、10.78%、15.69%、11.76%。观察组与对照组在年龄、孕周、产次方面对比差异无统计学意义(χ^(2)=0.164、0.054、0.144;P=0.685、0.817、0.705);观察组体质量指数(BMI)>28kg/m^(2)、切口长度>3cm、胎膜早破以及血糖控制不正常人数占比均显著高于对照组(χ^(2)=9.624、11.644、8.571、11.760;P=0.002、0.001、0.003、0.001)。多因素Logistic回归分析结果显示,BMI>28kg/m^(2)、切口长度>3cm、胎膜早破均是GDM孕妇分娩后会阴切口感染的独立危险因素(OR=1.201、1.662、2.015;P=0.002、0.004、0.000),血糖控制正常是保护性因素(OR=0.814;P=0.042)。结论GDM孕妇分娩后会阴切口感染和孕妇BMI、切口长度、胎膜早破、血糖控制效果密切相关。临床工作中可通过针对上述因素实施干预,从而达到降低感染的目的。

Objective To study the risk factors of perineal incision infection in pregnant women with gestational diabetes mellitus(GDM)after delivery and analyze the prevention and control measures.Methods From January 2015 to January 2020,60 pregnant women with GDM who underwent lateral perineal resection for vaginal delivery in our hospital and had postoperative perineal incision infection were selected,and were classified as the observation group.In addition,60 pregnant women with GDM who received lateral perineal incision for vaginal delivery in our hospital during the same period and did not have perineal incision infection after the operation were taken as the control group.The distribution of pathogenic bacteria in pregnant women in the infected group was analyzed,and the baseline data of the infected group and the control group were compared,and multivariate Logistic regression analysis was performed.Results A total of 102 pathogenic bacteria were detected in 60 patients with perineal incision infection,among which pseudomonas aeruginosa,escherichia coli,acinetobacter baumannii,staphylococcus aureus and staphylococcus epidermidis were the main pathogens,accounting for 28.43%,19.61%,10.78%,15.69% and 11.76%,respectively.There were no significant differences in age,gestational week and birth between the observation group and the control group(χ^(2)=0.164,0.054,0.144;P=0.685,0.817,0.705).The proportion of BMI>28kg/m 2,incision length>3cm,premature rupture of membranes and abnormal blood glucose control in the observation group were significantly higher than those in the control group(χ^(2)=9.624,11.644,8.571,11.760;P=0.002,0.001,0.003,0.001).Multivariate Logistic regression analysis showed that BMI>28 kg/m^(2),incision length>3cm and premature rupture of membranes were independent risk factors for perineal incision infection in pregnant women with GDM after delivery(OR=1.201,1.662,2.015;P=0.002,0.004,0.000),while normal blood glucose control was a protective factor(OR=0.814;P=0.042).Conclusion The infection of perineal incision after delivery in pregnant women with GDM is closely related to the pregnant women's BMI,incision length,premature rupture of membranes,and the effect of blood glucose control.Clinical work can be carried out in response to the above factors,so as to reduce the purpose of infection.