腹腔镜阑尾切除术后切口感染发生情况及高危因素分析

Analysis of incidence and high-risk factors of incision infection after laparoscopic appendectomy in patients with acute appendicitis

目的探讨急性阑尾炎(AA)患者行腹腔镜阑尾切除术(LA)治疗后切口感染发生情况及其影响因素。方法回顾性分析542例AA患者的临床资料,均行LA进行治疗,依据术后是否发生切口感染分为非感染组(n=462)与感染组(n=80)。采用调查问卷调查两组一般资料,并采取单因素分析、多因素Logistic回归分析法,分析LA术后发生切口感染的高危因素。结果542例患者中,共发生切口感染80例,切口感染发生率为14.76%(80/542)。单因素分析显示,感染组年龄>50岁、病程>24 h、病理类型为化脓性或坏疽穿孔性阑尾炎、合并基础疾病、手术时间>1.5 h及有吸烟史占比分别为67.5%(54/80)、66.3%(53/80)、72.5%(58/80)、62.5%(50/80)、68.8%(55/80)、36.3%(29/80),均高于非感染组的44.8%(207/462)、31.0%(143/462)、24.9%(115/462)、27.1%(125/462)、35.1%(162/462)、21.9%(101/462)(P<0.05)。多因素Logistic回归分析显示,年龄>50岁、病程>24 h、病理类型为化脓性或坏疽穿孔性阑尾炎、合并基础疾病、手术时间>1.5 h及有吸烟史均是导致AA患者行LA术后发生切口感染的高危因素(P<0.05)。结论年龄、病程、病理类型、合并基础疾病、手术时间及吸烟史均是导致AA患者术后切口感染发生的影响因素,临床护理过程中应加以重视,并开展相应的干预措施。

Objective To investigate the incidence and influencing factors of incision infection in patients with acute appendicitis(AA)after laparoscopic appendectomy(LA).Methods A retrospective analysis was conducted on the clinical data of 542 AA patients.All patients underwent LA treatment and were divided into a non-infection group(n=462)and an infection group(n=80)based on the occurrence of incision infection after surgery.Two sets of general data were surveyed using a survey questionnaire,and single factor analysis and multivariate Logistic regression analysis were used to analyze the risk factors of incision infection after LA surgery.Results Among 542 patients,80 cases of incision infection occurred,and the incidence of incision infection was 14.76%(80/542).Univariate analysis showed that the percentages of>50 years of age,disease duration>24 h,pathological type of purulent or gangrenous perforated appendicitis,comorbid underlying diseases,surgical time>1.5 h,and a history of smoking in the infection group were 67.5%(54/80),66.3%(53/80),72.5%(58/80),62.5%(50/80),68.8%(55/80),and 36.3%(29/80),which were higher than 44.8%(207/462),31.0%(143/462),24.9%(115/462),27.1%(125/462),35.1%(162/462),and 21.9%(101/462)in the non-infected group(P<0.05).Multivariate Logistic analysis showed that>50 years of age,disease duration>24 h,pathological type of purulent or gangrenous perforated appendicitis,comorbid underlying diseases,surgical time>1.5 h,and a history of smoking were all high-risk factors for postoperative incision infection in AA patients undergoing LA surgery(P<0.05).Conclusion Age,disease duration,pathological type,comorbidities with underlying diseases,surgical time,and smoking history are all influencing factors for postoperative wound infection in AA patients,Attention should be paid to the clinical nursing process and corresponding intervention measures should be implemented.