剖宫产术后产妇产褥感染危险因素分析

Analysis of risk factors for puerperal infection after cesarean section

目的分析剖宫产术后产妇产褥感染的危险因素及厚朴排气合剂疗效。方法选取2018年1月~2022年4月,于邢台市第三医院妇产科行剖宫产手术的1862例产妇。采集确定为剖宫产术后产褥感染产妇的分泌物进行病原菌鉴定。采集所有产妇生产前24 h,产后24、48、72 h的静脉血,检测血清中PCT、CRP水平。将本次研究中瘢痕子宫再次剖宫产术后发生产褥感染产妇分为观察组和对照组,观察组在产后常规护理基础上增加厚朴排气合剂进行辅助治疗,观察两组产妇的首次肛门排气、首次排便、肠鸣音恢复正常时间、初乳时间及产后24 h催乳素水平。结果1862例剖宫产孕妇,78例产后发生产褥感染,45例为子宫内膜炎症。785例分娩一次,感染率为1.91%;859例分娩2次,感染率为4.19%;218例分娩>2次,感染率为12.39%,三组产妇主要感染类型均为子宫内膜炎症。共检测到84株病原菌,阳性率97.87%,主要为单一病原菌感染。53株革兰阴性菌,主要为大肠埃希菌(34.52%),31株革兰阳性菌,主要为粪肠球菌(15.48%)。单因素分析结果显示,经产妇、手术时长≥90 min、第二产程剖宫产、胎膜早破、产后出血、生殖道感染、会阴侧切或撕裂、瘢痕子宫、妊娠期合并糖尿病、妊娠期合并高血压是剖宫产产妇发生产褥感染的危险因素。多元Logistic回归分析显示,经产妇、手术时长≥90 min、第二产程剖宫产、生殖道感染、瘢痕子宫、妊娠期合并糖尿病、妊娠期合并高血压是剖宫产产妇发生产褥感染的独立危险因素。78例剖宫产后发生产褥感染的产妇为感染组,100例同期剖宫产后未发生产褥感染的产妇为对照组。产后24 h,感染组产妇的PCT、CRP水平明显上升且上升幅度大,产后24、48及72 h,两组产妇的PCT、CRP水平差异有统计学意义(P<0.05)。选取33例瘢痕子宫再次剖宫产术后发生产褥感染,随机将其分为观察组与对照组,对比两组产妇首次肛门排气时间、首次排便时间、肠鸣音恢复正常时间及初乳时间,观察组明显短于对照组(P<0.05),两组产妇术后24 h催乳素水平差异无统计学意义(P>0.05)。结论剖宫产后发生产褥感染的病原菌主要为大肠埃希菌、阴道加德纳菌及粪肠球菌,经产妇、手术时长≥90 min、第二产程剖宫产、生殖道感染、瘢痕子宫、妊娠期合并糖尿病、妊娠期合并高血压是剖宫产产妇发生产褥感染的独立危险因素,感染组产妇的PCT、CRP水平在产后24、48及72 h明显上升。厚朴排气合剂有利于瘢痕子宫再次剖宫产术后发生产褥感染的产妇早排气、早进食、早泌乳,可促进产妇早日恢复。

Objective To analyze the risk factors of puerperal infection in parturients after cesarean section and the effect of Houpu Exhaust Mixture.Methods From January 2018 to April 2022,1862 parturients who underwent cesarean section in the Department of Obstetrics and Gynaecology of Xingtai Third Hospital were selected.The secretion of parturients who were determined to be puerperal infection after cesarean section for pathogen identification were collected.The venous blood of all parturients 24 hours before delivery,24 hours,48 hours and 72 hours after delivery were collected to detect the level of PCT and CRP in serum.The puerpera with postpartum mattress infection after cesarean section of scar uterus in this study were divided into observation group and control group.The observation group added Houpu Exhausting Mixture for auxiliary treatment on the basis of routine postpartum care,and observed the first anal exhaust,the first defecation,the time when the bowel sounds returned to normal,the time of colostrum and the level of prolactin 24 hours after delivery in the two groups.Results 1862 cases of cesarean section pregnant women,78 cases of postpartum puerperal infection,45 cases of endometritis.785 cases were delivered once,the infection rate was 1.91%;859 cases delivered twice,the infection rate was 4.19%;218 cases delivered more than twice,the infection rate was 12.39%.The main type of infection of the three groups of parturients was endometritis.A total of 84 strains of pathogenic bacteria were detected,with a positive rate of 97.87%,mainly due to single pathogen infection.53 strains of Gram negative bacteria,mainly Escherichia coli(34.52%),31 strains of Gram positive bacteria,mainly Enterococcus faecalis(15.48%).The results of univariate analysis showed that operation duration≥90 min,cesarean section in the second stage of labor,premature rupture of membranes,postpartum hemorrhage,genital tract infection,lateral episiotomy or tearing,scar uterus,pregnancy with diabetes,pregnancy with hypertension were the risk factors of puerpera with puerpera infection.Multivariate logistic regression analysis showed that the independent risk factors for puerperal infection in cesarean section women were multipara,operation duration≥90 min,cesarean section in the second stage of labor,genital tract infection,scar uterus,pregnancy with diabetes,and pregnancy with hypertension.78 parturients with postpartum puerperal infection after cesarean section were in the infection group,and 100 parturients without postpartum puerperal infection after cesarean section were in the control group.At 24 h postpartum,the PCT and CRP levels of the infected parturients increased significantly,and at 24 h,48 h and 72 h postpartum,there was a significant difference between the two groups(P<0.05).33 cases of puerpera with postpartum infection after cesarean section of scar uterus were randomly divided into the observation group and the control group.The time of first anal exhaust,the time of first defecation,the time of bowel sounds returning to normal and the time of colostrum were compared between the two groups.The observation group was significantly shorter than the control group(P<0.05).Conclusion The pathogens of puerperal infection after cesarean section were mainly E.coli,G.vaginalis and E.faecalis.The independent risk factors of puerperal infection in cesarean section women were postpartum women,operation duration≥90 min,cesarean section in the second stage of labor,genital tract infection,scar uterus,pregnancy with diabetes,and pregnancy with hypertension.The levels of PCT and CRP in infected women increased significantly at 24 h,48 h,and 72 h after delivery.Houpu Exhausting Mixture was beneficial to the early exhaust,early eating and early lactation of the puerpera infection after cesarean section of scar uterus,and can promote the early recovery of the puerpera.