化脓性阑尾炎患儿术后感染的高危因素分析

Analysis on high-risk factors of postoperative infection in children with suppurative appendicitis

目的探究化脓性阑尾炎患儿术后感染高危因素。方法回顾性分析2017年3月-2018年6月温州医科大学附属第二医院收治的化脓性阑尾炎患儿166例,观察所有患儿术后感染情况、病原菌分布,分析可能引起感染的相关因素,采用Logistic回归分析法分析引起患儿术后感染的高危因素。结果 166例患儿中4例发生术后感染,共检出28株细菌,其中革兰阴性菌20株占71.43%、革兰阳性菌8株占28.57%。年龄≥6岁患儿感染率、发病至手术时间≥12 h患儿感染率、术前未预防性使用抗生素患儿感染率、术前伴有内科疾病患儿感染率、手术时间>1 h患儿感染率、传统开腹手术患儿感染率、术后切口首次换药时间≥72 h患儿感染率均分别高于同组其他患儿,差异均有统计学意义(P<0.05)。Logistic回归分析显示发病至手术时间≥12 h、术前未预防性使用抗生素、术前伴有其他内科疾病、手术时间>1h、传统开腹手术、术后切口首次换药时间≥72 h是急性化脓性阑尾炎患儿术后发生感染的独立危险因素(P<0.05)。结论化脓性阑尾炎患儿术后感染与发病至手术时间、术前是否预防性使用抗生素、术前是否伴有其他内科疾病、手术时间、手术方式、术后切口首次换药时间有关,临床应根据这些危险因素及患儿具体病情采取针对性预防措施。

Objective To explore high-risk factors of postoperative infection in children with suppurative appendicitis.Methods From March 2017 to June 2018,166 children with suppurative appendicitis treated in the Second Affiliated Hospital of Wenzhou Medical University were retrospectively analyzed. Postoperative infection and pathogen distribution were observed,the related risk factors were analyzed. Logistic regression analysis was used to analyze the high-risk factors of postoperative infection in children. Results Among166 children with suppurative appendicitis,4 children were diagnosed as postoperative infection,28 strains of bacteria were detected,the proportions of Gram-negative bacteria and Gram-positive bacteria were 71. 43%( 20 strains) and 28. 57%( 8 strains),respectively. The infection rates among children aged 6 years old or more than 6 years old,time interval from onset to operation over 12 hours,without preoperative use of antibiotics,preoperative medical diseases,operation time more than 1 hour,traditional laparotomy,and initial wound dressing time beyond postoperative 72 hours were statistically significantly higher than those of the other children( P<0. 05). Logistic regression analysis showed that time interval from onset to operation over 12 hours,without preoperative use of antibiotics,preoperative medical diseases,operation time more than 1 hour,traditional laparotomy,and initial wound dressing time beyond postoperative 72 hours were independent risk factors of postoperative infection in children( P<0. 05). Conclusion Postoperative infection among children with suppurative appendicitis is related to time interval from onset to operation,preoperative use of antibiotics,preoperative medical diseases,operation time,traditional laparotomy,and initial wound dressing time,corresponding preventive measures should be taken based on the risk factors and condition of these children.