子宫腺肌症腹腔镜术后医院感染特点研究

Characteristics of postoperative nosocomial infection in adenomyosis patients undergoing laparoscopic surgery

目的研究子宫腺肌症患者腹腔镜术后医院感染的特点,为指导临床治疗提供依据。方法选择2013年4月-2018年2月于医院住院治疗的672例经腹腔镜手术治疗的子宫腺肌症患者作为研究对象,收集患者年龄、病史、手术时间、手术时机、住院时间、抗菌药物应用情况等人口学及临床数据,分析感染发生的影响因素。采集感染患者临床标本,应用全自动微生物分析仪进行病原菌鉴定。观察治疗前后感染患者炎性因子水平变化情况。结果 59例患者发生术后感染,感染率为8.78%(59/672),感染主要以呼吸道感染为主;手术时间≥3 h、子宫全切术、住院时间>5 d为子宫腺肌症患者腹腔镜术后感染的影响因素;59例感染患者共检出病原菌72株,革兰阴性菌36株占50.00%,以大肠埃希菌、肺炎克雷伯菌为主,革兰阳性菌28株占38.89%;以金黄色葡萄球菌、表皮葡萄球菌为主。感染患者术后血清炎性因子IL-6、TNF-α、TGF-β、hs-CRP较未感染组均升高(P<0.05),IL-8、IFN-γ水平比较差异无统计学意义。结论子宫腺肌症腹腔镜子宫切除或病灶切除后感染率较高,应针对影响因素采取有效的预防措施,同时及时监控炎症因子的变化,有利于对感染的控制及治疗。

OBJECTIVE To observe the characteristics of postoperative nosocomial infection in the adenomyosis patients undergoing laparoscopic surgery so as to provide guidance for clinical treatment.METHODS A total of 672 patients with adenomyosis who were hospitalized and underwent laparoscopic surgery from Apr 2013 to Feb 2018 were recruited as the study objects,the demographic and clinical data involving age,medical history,operation duration,operation opportunity,length of hospital stay and use of antibiotics were collected from the patients,the influencing factors for the infection were analyzed,the clinical specimens were collected from the patients with infection,the isolated pathogens were identified by using automatic microorganism analysis system,and the levels of inflammatory factors of the patients with infection were observed before and after the treatment.RESULTS Totally 59 patients had postoperative infection,with the infection rate 8.78%(59/672),and the patients with respiratory tract infection were dominant.Operation duration no less than 3 hours,total hysterectomy and length of hospital stay more than 5 days were the influencing factors for the postoperative infection in the adenomyosis patients undergoing laparoscopic surgery.Totally 72 strains of pathogens were isolated from the 59 patients with infection,36(50.00%)of which were gram-negative bacteria,and 28(38.89%)were gram-positive bacteria;Escherichia coli and Klebsiella pneumoniae were the predominant species of the gram-negative bacteria;Staphylococcus aureus and Staphylococcus epidermidis were dominant among the gram-positive bacteria.The levels of serum inflammatory factors IL-6,TNF-α,TGF-βand hs-CRP of the patients with infection were significantly higher than those of the patients without infection after the surgery(P<0.05);there were no significant differences in the levels of IL-8 and IFN-γ.CONCLUSION The incidence of infection is high in the adenomyosis patients after the laparoscopic surgery or resection of lesions.It is necessary to take effective prevention measures according to the influencing factors and monitor the levels of inflammatory factors so as to control and treat the infection.