腹部手术患者切口感染的病原菌特点及影响因素分析

Distribution of pathogens isolated from abdominal surgery patients with incision infections and influencing factors

目的分析并探究腹部手术患者切口感染的相关因素及预防措施。方法选择2014年7月到2017年7月海南省三亚市人民医院收治的腹部手术后切口感染患者60例作为感染组,选择同期内在该医院完成腹部手术但未发生切口感染的患者60例作为对照组,回顾性分析两组的数据。对比分析术后切口对患者住院指标的影响、术后切口感染的病原菌分布特点,并对相关影响因素进行单因素和Logistic多因素回归分析。结果观察组患者的术后排气时间、下床活动时间及住院时间、住院费用明显高于对照组患者(P<0.05)。切口感染病原菌:革兰阴性菌与革兰阳性菌、真菌相比较多(P<0.05)。经单因素和Logistic多因素分析显示,手术时间、手术参观人数、是否有植入性器械与患者切口感染密切相关且为影响因素(P<0.05)。结论腹部手术后切口感染菌株为革兰阳性菌与革兰阴性菌,且以革兰阴性菌为主,针对手术时间、手术参观人数、是否有植入性器械等相关影响因素进行必要的预防对策,可尽最大程度避免术后切口感染的发生,提高临床医疗质量。

OBJECTIVE To investigate the influencing factors for incision infections in the patients undergoing abdominal surgery and put forward the prevention measures.METHODS From Jul 2014 to Jul 2017,totally 60 patients who received abdominal surgery and had postoperative incision infections in Sanya People’s Hospital of Hainan Province were chosen as the infection group,meanwhile,60 patients who received abdominal surgery but did not have incision infection were assigned as the control group.The data of the two groups of patients were retrospectively analyzed,the influence of postoperative incision infections on hospital stay indexes was observed and compared,the distribution of pathogens causing the postoperative incision infections was analyzed,and univariate analysis and multivariate logistic regression analysis were performed for the influencing factors.RESULTS The time of postoperative exhaust,time of getting out of bed and length of hospital stay were significantly longer in the observation group than in the control group,the hospitalization cost was significantly more in the observation group than in the control group(P<0.05).Gram-negative bacteria,gram-positive bacteria and fungi were dominant among the pathogens causing the incision infections(P<0.05).Univariate analysis and multivariate logistic analysis indicated that operation duration,number of visiting people and implantable device were closely associated with the incision infections and were the influencing factors(P<0.05).CONCLUSIONThe gram-positive bacteria and gram-negative bacteria are the pathogens isolated from the abdominal surgery patients with postoperative incision infections,and the gram-negative bacteria are dominant.It is necessary to put forward the prevention countermeasures according to the related influencing factors such as operation duration,number of visiting people and implantable device so as to prevent the postoperative incision infections and improve the medical quality.