营养状态对结直肠癌病人手术部位感染的影响及相关因素分析

Analysis of the influencing factors for SSI in colorectal cancer patients with different nutrition disorder

目的:调查不同营养状态的结直肠癌病人术后手术部位感染(SSI)的发生情况,并分析其影响因素。方法:回顾性收集2015年1月至2019年12月在南京江北医院因结直肠癌行手术治疗的95例营养不良、超重或肥胖的营养状态异常病人,选取同期行同种手术治疗的141例营养正常的结直肠癌病人作为对照,收集病人的基本信息、围手术期相关信息及SSI发生情况等资料,分别分析各组病人SSI发生的影响因素。结果:营养状态异常的结直肠癌病人术后SSI总体发生率为18.95%(营养不良组、超重组、肥胖组SSI发生率分别为9.09%、17.74%、45.45%),营养正常组病人SSI发生率为15.60%。肥胖组SSI发生率显著高于其他三组(P=0.030)。术前低白蛋白是营养不良组病人SSI发生的危险因素(P=0.014);术前有营养风险(P=0.005)、Ⅲ类切口(P=0.035)是超重组病人SSI发生的危险因素,而使用腹腔镜辅助手术是其保护性因素(P=0.021)。结论:术前应充分评估结直肠癌病人的营养风险,纠正营养状态,以预防术后SSI的发生。

Objective:To investigate the incidence of surgical site infection(SSI)in colorectal cancer patients with different nutrition disorder and analyze the influencing factors for SSI.Methods:A total of 236 colorectal cancer patients who underwent surgery in Nanjing Jiangbei Hospital were collected retrospectively from January 2015 to December 2019,of which 95 patients were nutrition disorder.The demographic characteristics,perioperative information and the SSI rate were collected.The influencing factors of SSI were analyzed.Results:The overall incidence of postoperative SSI in colorectal cancer patients with nutritionally disorders was 18.95%(the incidence of SSI was 9.09%,17.74%,45.45%in the malnutrition group,overweight group and obesity group,respectively),and the incidence of SSI in patients with normal nutrition was 15.60%.The incidence of SSI in the obesity group was significantly higher than in the other three groups(P=0.030).A lower level of preoperative albumin was a independent risk factor for SSI in malnutrition group(P=0.014);Preoperative NRS 2002(P=0.005)and surgical incision classⅢ(P=0.035)were risk factors for SSI in overweight group,and laparoscopically assisted procedures was a protective factor(P=0.021).Conclusions:The nutritional risk of should be fully evaluated and the nutritional disorder should be intervened before operation to prevent the occurrence of SSI.