β-内酰胺类抗生素过敏对开腹胃癌根治术患者手术部位感染的影响

Effect of β-lactam antibiotic allergy on surgical site infection in patients undergoing open surgery for gastrointestinal tumor

目的探讨和β-内酰胺类(beta-lactam,BL)抗生素非过敏患者相比较,BL过敏是否会增加开腹胃癌根治手术患者手术部位感染(surgical site infection,SSI)的发病率。方法选取2018年3月—2023年2月在濮阳油田总医院进行治疗的胃癌行开腹手术患者303例。根据患者BL过敏状况对其进行分组,病历中术前报告BL过敏患者作为过敏组,病历中术前未报告BL过敏患者作为非过敏组。对比两组患者的SSI发病率。应用logisitic回归模型探讨影响患者术后SSI发病的相关因素。结果303例胃癌开腹手术患者中,术后SSI发病率4.29%。其中:BL过敏组患者SSI发病率15.38%;非BL过敏组SSI发病率3.79%。差异有统计学意义(P<0.05);在排除预防性应用BL类、非BL类抗生素因素作为自变量的条件下,年龄大、糖尿病、手术风险分级高、术中输血、BL过敏是患者发生SSI的危险因素(P<0.05);在纳入预防性应用BL类、非BL类抗生素因素作为自变量的条件下,腹部手术史、糖尿病、手术风险分级高、应用非BL类抗生素是患者SSI发病的危险因素(P<0.05)。结论BL过敏患者SSI增加的原因可能与其非BL类抗生素用药方案有关。

Objective To explore whether BL allergy can increase the incidence of SSI in patients undergoing open surgery for gastrointestinal tumors compared with those who are not allergic to BL antibiotics.Methods From March 2018 to February 2023,a total of 303 patients undergoing laparotomy for gastric cancer were treated in Puyang Oilfield General Hospital.Patients were divided into groups according to their BL allergy status.Patients who reported BL allergy before operation in medical records were regarded as allergic group,while patients who did not report BL allergy before operation were regarded as non-allergic group.Compare the incidence of SSI between the two groups.The logisitic regression model was used to explore the related factors affecting the incidence of SSI after operation.Results In 303 patients with gastric cancer undergoing open surgery,the incidence rate of SSI after surgery was 4.29%.Among them,the incidence rate of SSI in BL allergy group was 15.38%;The incidence rate of SSI in non BL allergic group was 3.79%.The difference was statistically significant(P<0.05).Under the condition of excluding the preventive application of BL and non-BL anti-biotics as self-variable;The risk factors of SSI were age,diabetes,high grade of operation risk,blood transfusion during operation and BL allergy(P<0.05);Taking preventive use of BL antibiotics and non-BL antibiotics as independent variables,abdominal operation history,diabetes,high risk classification of operation and application of non-BL antibiotics are the risk factors of SSI(P difference 0.05).Conclusion The increase of SSI in patients with BL allergy may be related to the medication regimen of non-BL antibiotics.