剖宫产术后切口感染影响因素的Meta分析

Meta-analysis of influencing factors of surgical site infection after cesarean section

[目的]通过Meta分析探讨剖宫产产妇术后切口感染(SSI)的主要影响因素。[方法]计算机检索PubMed、EMBASE、中国生物医学文献数据库、中国知网、万方数据库以及中国科技期刊数据库中2008年—2018年公开发表的剖宫产产妇术后SSI危险因素病例对照研究。采用RevMan 5.3软件对纳入文献进行Meta分析。[结果]共纳入18项研究,NOS评分6~8分。Meta分析结果显示:病例组年龄[样本量<100例组:WMD=1.95,95%CI(0.98,2.93),P<0.01;样本量<100例组:WMD=-1.50,95%CI(-1.98,-1.02),P<0.01]、体质指数[WMD=1.83,95%CI(1.05,2.60),P<0.01]、手术季节[OR=1.76,95%CI(1.36,2.28),P<0.01]、病房人数[WMD=2.86,95%CI(2.03,4.03),P<0.01]、阴道/肛门检查次数[WMD=1.27,95%CI(1.21,1.34),P<0.001]、合并基础疾病情况[OR=3.15,95%CI(2.09,4.75),P<0.01]、合并生殖道感染情况[OR=3.05,95%CI(1.97,4.72),P<0.01]、试产时间[WMD=2.13,95%CI(1.80,2.45),P<0.001]、胎膜早破情况[OR=2.82,95%CI(2.13,3.74),P<0.01]、急诊剖宫产情况[OR=3.09,95%CI(2.33,4.10),P<0.001]、术前抗生素使用情况[OR=4.56,95%CI(3.53,5.89),P<0.001]、备皮至手术时间[WMD=3.24,95%CI(2.86,3.87),P<0.001]、手术时间[WMD=0.31,95%CI(0.24,0.38),P<0.01]、术中出血量[WMD=47.58,95%CI(42.86,52.29),P<0.001]及住院时间[WMD=4.36,95%CI(3.88,4.97),P<0.001]与对照组比较,差异有统计学意义。[结论]现有证据表明:年龄、体质指数、手术季节、病房人数、阴道/肛门检查次数、合并基础疾病情况、合并生殖道感染情况、试产时间、胎膜早破情况、急诊剖宫产情况、术前抗生素使用情况、备皮至手术时间、手术时间、术中出血量、住院时间是剖宫产产妇术后SSI的影响因素,但因纳入研究总体方法学质量一般,尚需更多高质量、大样本病例对照研究对结果进行进一步验证。

Objective:To probe into the main influencing factors of surgical site infection(SSI)among puerperae cesarean section.Methods:Databases including PubMed,EMBASE,CBM,CNKI,Wanfang Data and VIP were searched by computer for case-control studies on SSI risk factors of cesarean section from 2008 to 2018.RevMan 5.3 software was used for meta-analysis in included literatures.Results:A total of 18 studies were included,in which NOS scores ranging from 6 to 8.Meta analysis showed that age[sample size<100 cases group:WMD=1.95,95%CI(0.98,2.93),P<0.01;sample size<100 cases group:WMD=-1.50,95%CI(-1.98,-1.02),P<0.01],body mass index[WMD=1.83,95%CI(1.05,2.60),P<0.01],surgery season[OR=1.76,95%CI(1.36,2.28),P<0.01],number of patients in ward[WMD=2.86,95%CI(2.03,4.03),P<0.01],vagina/anus examination times[WMD=1.27,95%CI(1.21,1.34),P<0.001],combined underlying diseases[OR=3.15,95%CI(2.09,4.75),P<0.01],complicated reproductive tract infection[OR=3.05,95%CI(1.97,4.72),P<0.01],trial delivery time[WMD=2.13,95%CI(1.80,2.45),P<0.001],premature rupture of membranes[OR=2.82,95%CI(2.13,3.74),P<0.01],emergency cesarean section[OR=3.09,95%CI(2.33,4.10),P<0.001],preoperative use of antibiotics[OR=4.56,95%CI(3.53,5.89),P<0.001],time from skin preparation to operation[WMD=3.24,95%CI(2.86,3.87),P<0.001],operation time[WMD=0.31,95%CI(0.24,0.38),P<0.01],intraoperative bleeding[WMD=47.58,95%CI(42.86,52.29),P<0.001]and hospital stay[WMD=4.36,95%CI(3.88,4.97),P<0.001]of case group were significantly different from those of control group.Conclusions:Present evidences showed that these factors,including age,body mass index,surgery season,number of patients in ward,vagina/anus examination times,combined underlying diseases,complicated reproductive tract infection,trial delivery time,premature rupture of membranes,emergency cesarean section,preoperative use of antibiotics,the time from skin preparation to operation,operation time,intraoperative bleeding and hospital stay were all influencing factors of SSI after cesarean section.However,due to the general methodological quality of the study,more high-quality and large sample case-control studies were needed to further verify the results.