BMI指数与血红蛋白水平和T淋巴细胞CD4+/CD8+的变化与妇产科患者术后感染的关系

Correlation between BMI, hemoglobin level, T lymphocyte CD4+/CD8+ and postoperative infection in department of obstetrics and gynecology

目的探讨体质量指数(BMI)、血红蛋白(Hb)水平和T淋巴细胞CD4+/CD8+比值的变化与妇产科患者术后感染的关系。方法选择医院2016年1月-2018年3月行妇产科手术患者或剖宫产产妇1962例为研究对象,统计术后感染率,感染部位,病原菌分布。单因素及多因素分析BMI、Hb、CD4+/CD8+变化及其他临床资料与术后感染的关系。结果 61例发生感染,感染率为3.11%。主要为切口感染,其次为泌尿系统和呼吸系统感染。共检出61株病原菌,其中革兰阴性菌38株,占62.30%;革兰阳性菌21株,占34.43%;真菌2株,占3.28%。多因素分析结果显示:年龄≥60岁,Hb<90 g/l,BMI≥25 kg/m2,手术时间≥2 h,侵入性操作,开腹手术,恶性疾病、CD4+/CD8+<1.4是妇产科患者术后感染的独立危险因素。结论妇产科患者术后医院感染是常见的并发症,切口感染是常见的感染部位,病原菌以革兰阴性菌为主,BMI>25 kg/m2,Hb<90 g/l,CD4+/CD8+<1.4更容易发生感染。

OBJECTIVE To explore the correlation between body mass index(BMI),hemoglobin(Hb)level,T lymphocyte CD4+/CD8+and postoperative infection in department of obstetrics and gynecology.METHODS A total of 1962 patients and puerpera who received surgical procedures and cesarean section from Jan 2016 to Mar 2018 were recruited as the study objects.The incidence of postoperative infection,infection sites and distribution of pathogens were statistically analyzed.Univariate analysis and multivariate analysis were performed to observe the correlation between the BMI,hemoglobin level,T lymphocyte CD4+/CD8+and the postoperative infection.RESULTS Totally 61 patients had the infection,with the infection rate 3.11%.The patients with incision infection were dominant,followed by the patients with urinary system infection and the patients with respiratory system infection.A total of 61 strains of pathogens were isolated,38(62.30%)of which were gram-negative bacteria,21(34.43%)were gram-positive bacteria,and 2(3.28%)were fungi.The result of multivariate analysis showed that the independent risk factors for the postoperative infection in the department of obstetrics and gynecology included no less than 60 years of age,Hb less than 90 g/l,BMI no less than 25 kg/m2,operation duration no less than 2 hours,invasive operation,laparotomy,malignant disease and CD4+/CD8+less than 1.4.CONCLUSION The postoperative nosocomial infection is the common complication in the department of obstetrics and gynecology,the incision is the common infection site.The gram-negative bacteria are dominant among the pathogens.The patients with the BMI more than 25 kg/m2,Hb less than 90 g/l and CD4+/CD8+less than 1.4 are more likely to have infection.