腹部手术后手术部位感染的影响因素分析

Influencing factors of surgical site infection after abdominal surgery

目的探讨腹部手术后手术部位感染(SSI)的影响因素。方法采用回顾性横断面研究方法。收集2020年6月1-30日我国6家医学中心收治的567例(郑州大学附属郑州中心医院445例、郑州大学第一附属医院54例、商丘市第一人民医院49例、洛阳市中心医院10例、河南科技大学第一附属医院5例、河南省人民医院4例)行腹部手术患者的临床资料;男284例, 女283例;年龄为(51±18)岁。观察指标:(1)术后SSI发生情况。(2)术后发生SSI的影响因素分析。采用门诊和电话方式进行随访, 了解患者术后SSI发生情况, 无植入物患者随访时间为术后30 d、有植入物患者随访至术后1年。正态分布分布的计量资料以x±s表示, 组间比较采用独立样本t检验;偏态分布的计量资料以M(范围)表示, 组间比较采用Mann-WhitneyU检验。计数资料以绝对数或百分比表示, 组间比较采用χ^(2)检验或Fisher确切概率法。单因素分析采用对应的统计学检验方法。多因素分析采用Logistic逐步回归模型前进法。结果 (1)术后SSI发生情况。567例患者术后均按计划获得随访, 术后发生SSI 27例, 其中浅表切口感染、深部切口感染、器官和(或)腔隙感染各9例。27例发生SSI患者中, 分泌物及脓液细菌培养阳性18例, 病原菌依次为大肠埃希菌8例, 肺炎克雷伯菌6例, 屎肠球菌3例, 铜绿假单胞菌1例。(2)术后发生SSI的影响因素分析。单因素分析结果显示:年龄、术前血红蛋白、术前白蛋白、术前空腹血糖、术前肠道准备、手术类型、手术部位、手术切口类型、手术时间、入住重症监护室(ICU)时间、术后住院时间、总住院时间、住院费用是腹部手术患者术后发生SSI的相关因素(χ^(2)=40.12, Z=-4.22、-2.21、-4.75, χ^(2)=7.07、16.43、38.06、17.50, Z=-4.43、-4.42、-7.14、-7.15、-5.90, P<0.05);美国麻醉医师协会分级、术前口服抗菌药物、手术方式、术后入住重症监护室是腹部手术患者术后发生SSI的相关因素(P<0.05)。多因素分析结果显示:年龄、术前空腹血糖、术前肠道准备、手术类型、手术部位为阑尾、手术部位为结直肠、手术方式、手术切口类型为感染切口、手术切口类型为污染切口、手术时间是腹部手术患者术后发生SSI的独立影响因素(优势比=7.69, 1.21, 0.27, 5.82, 5.19, 19.08, 0.23, 27.76, 4.97, 1.01, 95%可信区间为2.04~28.95, 1.04~1.41, 0.08~0.94, 1.36~24.85, 1.10~24.43, 4.48~81.25, 0.06~0.87, 2.54~303.53, 1.12~22.14, 1.01~1.02, P<0.05)。结论年龄、术前空腹血糖、术前肠道准备、手术类型、手术部位、手术方式、手术切口类型、手术时间是腹部手术患者术后发生SSI的独立影响因素。

Objective To investigate the influencing factors of surgical site infection(SSI)after abdominal surgery.Methods The retrospective cross-sectional study was conducted.The clinical data of 567 patients undergoing abdominal surgery in 6 medical centers,including 445 cases in the Zhengzhou Central Hospital Affiliated to Zhengzhou University,54 cases in the the First Affiliated Hospital of Zhengzhou University,49 cases in the Shangqiu First People's Hospital,10 cases in the Luoyang Central Hospital,5 cases in the First Affiliated Hospital of Henan University of Science and Technology and 4 cases in the Henan Provincial People's Hospital,from June 1 to June 30,2020 were collected.There were 284 males and 283 females,aged(51±18)years.Observation indicators:(1)incidence of SSI after surgery;(2)influencing factors of SSI.Follow-up was conducted using outpatient examination and telephone interview to detect the incidence of SSI.Patients without implant were followed up within postoperative 30 days,and patients with implant were followed up within postoperative 1 year.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was conducted using the independent sample t test.Measurement data with skewed distribution were represented as M(range),and comparison between groups was conducted using the Mann‐Whitney U test.Count data were described as absolute numbers or percentages,and comparison between groups was performed using the chi‐square test or Fisher exact probability.Univariate analysis was performed using the corresponding statistical methods.Multivariate analysis was performed using the Logistic stepwise regression model advance method.Results(1)Incidence of SSI after surgery.All the 567 patients were followed up after surgery as planned.There were 27 cases with SSI after surgery including 9 cases with superficial incision infection,9 cases with deep incision infection,9 cases with organ/gap infection.Of the 27 cases with SSI after surgery,18 cases with positive results of incisional microbial culture including 8 cases with positive results of Escherichia coli,6 cases with positive results of Klebsiella pneumonia,3 cases with positive results of Enterococcus faecium and 1 case with positive result of Pseudomonas aeruginosa.(2)Influencing factors of SSI.Results of univariate analysis showed that age,preoperative hemoglobin,preoperative albumin,preoperative fasting blood glucose,preoperative intestinal preparation,surgical type,surgical site,surgical incision type,duration of intensive cure unite,duration of postoperative hospital stay,duration of total hospital stay,operation time,hospital expense were related factors affecting the incidence of SSI of patients undergoing abdominal surgery(χ^(2)=40.12,Z=‒4.22,‒2.21,‒4.75,χ^(2)=7.07,16.43,38.06,17.50,Z=‒4.43,‒4.42,‒7.14,‒7.15,‒5.90,P<0.05)and the American Association of Anesthesiologists Classification,preoperative oral antibiotics,surgical methods and postoperative intensive care unit stay were related factors affecting the incidence of SSI of patients undergoing abdominal surgery(P<0.05).Results of multivariate analysis showed that age,preoperative fasting blood glucose,preoperative intestinal preparation,surgical type,surgical site as appendix and rectum,surgical methods,surgical incision type as infective incision and polluted incision,operation time were independent factors affecting the incidence of SSI of patients undergoing abdominal surgery(odds ratio=7.69,1.21,0.27,5.82,5.19,19.08,0.23,27.76,4.97,1.01,95%confidence intervals as 2.04‒28.95,1.04‒1.41,0.08‒0.94,1.36‒24.85,1.10‒24.43,4.48‒81.25,0.06‒0.87,2.54‒303.53,1.12‒22.14,1.01‒1.02,P<0.05).Conclusion Age,preoperative fasting blood glucose,preoperative intestinal preparation,surgical type,surgical site as appendix and rectum,surgical methods,surgical incision type as infective incision and polluted incision,operation time are independent factors affecting the incidence of SSI of patients undergoing abdominal surgery.