妊娠期糖尿病患者剖宫产术后切口感染的影响因素及血清降钙素原、糖化血红蛋白对感染风险的预测价值研究

Influencing Factors of Incision Infection after Cesarean Section in Patients with Gestational Diabetes Mellitus and the Predictive Value Study of Serum Procalcitonin and Glycosylated Hemoglobin on Infection Risk

目的:分析妊娠期糖尿病(GDM)患者剖宫产术后切口感染的影响因素并探讨血清降钙素原(PCT)、糖化血红蛋白(HbA1c)对感染风险的预测价值。方法:选取2020年1月~2022年1月我院收治的253例行剖宫产术的GDM患者,根据剖宫产术后是否发生切口感染分为感染组和非感染组。检测血清PCT、HbA1c水平,采用单因素和多因素Logistic回归分析GDM患者剖宫产术后切口感染的影响因素,受试者工作特征(ROC)曲线分析血清PCT和HbA1c对GDM患者剖宫产术后切口感染的预测价值。结果:253例GDM患者剖宫产术后切口感染发生率为15.02%(38/253)。单因素分析显示,感染组年龄≥35岁、手术时间≥1 h、术中出血量≥500 m L、肛检/阴检≥3次、羊水污染、胎膜早破、生殖道炎症比例和PCT、HbA1c高于非感染组,预防性使用抗菌药物比例低于非感染组(P均<0.05)。多因素Logistic回归分析显示,手术时间≥1 h、肛检/阴检≥3次、羊水污染、胎膜早破、生殖道炎症、PCT升高、HbA1c升高为GDM患者剖宫产术后切口感染的独立危险因素(P<0.05),预防性使用抗菌药物为其独立保护因素(P<0.05)。ROC曲线分析显示,血清PCT和HbA1c单独与联合预测GDM患者剖宫产术后切口感染的曲线下面积分别为0.797、0.774、0.875。结论:手术时间、预防性使用抗菌药物、肛检/阴检、羊水污染、胎膜早破、生殖道炎症、PCT和HbA1c为GDM患者剖宫产术后切口感染的影响因素,术前血清PCT和HbA1c联合预测剖宫产术后切口感染的价值较高。

Objective:To analyze the influencing factors of incision infection after cesarean section in patients with gestational diabetes mellitus(GDM)and to explore the predictive value of serum procalcitonin(PCT)and glycosylated hemoglobin(HbA1c)on the infection risk.Methods:253 patients with GDM who underwent cesarean section in our hospital from January 2020 to January 2022 were selected,and they were divided into infection group and non-infection group according to whether incision infection occurred after cesarean section.Serum PCT and HbAlc levels were detected.Univariate and multivariate Logistic regression were used to analyze the influencing factors of incision infection after cesarean section in patients with GDM.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of serum PCT and HbAlc on incision infection after cesarean section in patients with GDM.Results:The incidence of incision infection after cesarean section in 253 patients with GDM was 15.02%(38/253).Univariate analysis showed that age greater than or equal to 35 years,operation time≥1 h,intraoperative blood loss greater than or equal to 500 mL,anal examination/vaginal examination≥3 times,amniotic fluid contamination,premature rupture of membranes,genital tract inflammation ratio,PCT and HbAlc in the infection group were higher than in the non-infection group,and the proportion of prophylactic use of antibiotics was lower than that in the non-infection group(all P<0.05).Multivariate Logistic regression analysis showed that operation time≥1 h,anal examination/vaginal examination≥3 times,amniotic fluid contamination,premature rupture of membranes,genital tract inflammation,increased PCT,and increased HbAlc were independent risk factors for incision infection after cesarean section in patients with GDM(P<0.05).Prophylactic use of antibiotics was an independent protective factor(P<0.05).ROC curve analysis showed that the area under curve of serum PCT and HbA1c in predicting incision infection after cesarean section in patients with GDM were 0.797,0.774 and 0.875,respectively.Conclusion:Operation time,prophylactic use of antibiotics,anal examination/vaginal examination,amniotic fluid contamination,premature rupture of membranes,genital tract inflammation,PCT and HbA1c are the influencing factors of incision infection after cesarean section in patients with GDM.The combined preoperative serum PCT and HbAlc has a high value in predicting incision infection after cesarean section.