剖宫产切口感染危险因素及厚朴排气合剂临床应用效果分析

Risk factors of incision infection in cesarean section and clinical application of houpu exhaust mixture

目的探讨剖宫产切口感染病原菌分布及危险因素,为临床合理使用抗生素及降低感染发生提供参考。方法回顾性调查分析本院2016-2020年接受剖宫产手术的1712例患者临床资料,对发生切口感染的74例患者进行病原菌检测。SPSS 25.0软件统计分析导致腹部切口感染的影响因素及增加厚朴排气合剂联合腹部按摩临床疗效。结果5年来本院剖宫产主要手术指征,社会因素所致的剖宫产率由2016年的20.11%下降至2020年的11.11%。产科并发症所致的剖宫产率由24.90%降低至12.12%。瘢痕子宫所致的剖宫产率由14.94%升至33.84%,目前已成为产妇进行剖宫产的第一手术指征。1712例剖宫产产妇,术后发生切口感染74例,感染率为4.32%。浅层感染68例(91.89%),深层感染6例(8.11%)。共检出病原菌74株,其中革兰阴性菌45株(60.81%),革兰阳性菌27株(36.49%),真菌2株(2.70%)。影响切口感染因素分析发现,初产妇、剖宫产史、多人病房、BMI(≥30 kg/m^(2))、剖宫产类型、阴道指检次数(≥5)、术中时间(≥1.5 h)、术中出血量(≥500 ml)、留置尿管时间(≥24 h)、疤痕子宫、羊水污染、妊娠综合征,差异有统计学意义(P<0.05),均为剖宫产术后切口感染的影响因素。年龄、贫血、胎膜早破,差异无统计学意义(P>0.05),与切口感染无明显相关性。BMI、阴道指检次数、术中时间、术中出血量、瘢痕子宫、羊水污染是引发剖宫产术后腹部切口感染的高危因素。增加厚朴排气合剂联合腹部按摩进行干预治疗后,观察组患者首次排便、肛门排气、初乳时间均显著早于对照组患者,血性恶露持续时间明显少于对照组患者,差异有统计学意义(P<0.05)。结论剖宫产主要手术指征为瘢痕子宫,切口感染病原菌以革兰阴性菌为主,危险因素明确。增加厚朴排气合剂联合腹部按摩临床疗效显著。

Objective The distribution of pathogens and risk factors of cesarean section incision infection were explored,so as to provide reference for clinical rational use of antibiotics and reducing the incidence of infection.Method The clinical data of 1712 patients who underwent cesarean section in our hospital from 2016 to 2020 were retrospectively investigated and analyzed,and 74 patients with incision infection were detected for pathogens.SPSS 25.0 software was used to analyze the influencing factors of abdominal incision infection and increase the clinical efficacy of Houpu exhaust mixture combined with abdominal massage.Result By analyzing the main surgical indications of cesarean section in our hospital in recent 5 years,the cesarean section rate caused by social factors decreased from 20.11%in 2016 to 11.11%in 2020.The cesarean section rate caused by obstetric complications decreased from 24.90%in 2016 to 12.12%in 2020.The cesarean section rate caused by scar uterus shows a gradual upward trend,from 14.94%in 2016 to 33.84%in 2020.At present,it has become the first surgical indication for cesarean section.In 1712 cases of cesarean section,74 cases of incision infection occurred after operation,and the infection rate was 4.32%.There were 68 cases of superficial infection(91.89%)and 6 cases of deep infection(8.11%).A total of 74 strains of pathogens were detected,including 45 strains of Gram-negative bacteria(60.81%),27 strains of Gram-positive bacteria(36.49%)and 2 strains of fungi(2.70%).Univariate analysis of incision infection showed that primipara,cesarean section history,multi person ward,BMI(≥30 kg/m~2),cesarean section type,vaginal digital examination times(≥5),intraoperative time(≥1.5 h),intraoperative bleeding(≥500 ml),indwelling catheter time(≥24 h),scarred uterus,sheep water pollution and pregnancy syndrome were the influencing factors of incision infection after cesarean section(P<0.05),and there was no significant correlation with incision infection.BMI,vaginal digital examination times,intraoperative time,intraoperative bleeding,scarred uterus and amniotic fluid pollution are the high-risk factors of abdominal incision infection after cesarean section.After the intervention treatment of Houpu exhaust mixture combined with abdominal massage,the first defecation,anal exhaust and colostrum time of patients in the observation group were significantly earlier than those in the control group,and the duration of bloody lochia was significantly shorter than those in the control group(P<0.05).Conclusion The main surgical indication of cesarean section is scar uterus.The pathogen of incision infection is mainly Gram-negative bacteria,and the risk factors are clear.The clinical effect of increasing Houpu exhaust mixture combined with abdominal massage is significant.