降钙素原联合C-反应蛋白对产妇会阴侧切术后感染预测价值分析
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摘要
目的研究降钙素原(PCT)联合C-反应蛋白(CRP)在会阴侧切手术后,其切口感染的临床诊断及预测价值分析,为防治会阴侧切术后的切口感染提供参考。方法回顾性选取2017年1月-2017年12月在郑州大学第三附属医院产科入院预备分娩产妇180例,观察并记录产妇侧切术后切口感染情况,采集感染产妇切口局部分泌物,进行病原菌的分离及培养。分析PCT及CRP指标水平对侧切术后感染的预测价值。结果 180例接受会阴侧切手术的产妇中,15例患者发生切口感染,感染率为8.33%。切口局部分泌物共培养出11株病原菌,阳性检出率为73.33%(11/15),主要病原菌为大肠埃希菌。会阴侧切术前,PCT和CRP检测呈阳性的产妇术后切口感染率分别为23.52%和15.15%,均高于检测呈阴性的产妇,比较差异有统计学意义(均P<0.05)。结论会阴侧切术前PCT和CRP检测呈阳性的产妇,术后有较大的可能性发生切口感染;术前PCT联合CRP检测对预测术后切口感染具有一定参考价值。
OBJECTIVE To explore the value of procalcitonin(PCT)combined with C-reactive protein(CRP)in clinical diagnosis and prediction of postoperative incision infection in the puerpera undergoing lateral episiotomy.METHODS A total of 180 puerpera who were admitted to the obstetrics department of Third Affiliated Hospital of Zhengzhou University for labor from Jan 2017 to Dec 2017 were retrospectively enrolled in the study,the prevalence of postoperative incision infection of the lateral episiotomy puerpera was observed,the ecretions specimens were collected form the incision sites of the puerpera with infection,the pathogens were isolated,and the value of PCT and CRP in prediction of the postoperative infection was observed.RESULTS Of the 180 puerpera who underwent the lateral episiotomy,15 had incision infection,with the infection rate 8.33%.Totally 11 strains of pathogens were isolated from the local incision secretions,with the positive detection rate 73.33%(11/15);Escherichia coli was the predominant species of pathogen.The incidence rates of postoperative incision infection of the puerpera who were tested positive for PCT and CRP were respectively 23.52% and 15.15% before the lateral episiotomy,higher than those of the puerpera who were tested negative,and there were significant differences(all P<0.05).CONCLUSIONThe puerpera who are tested positive for PCT and CRP before the lateral episiotomy are at high risk of postoperative incision infection.The preoperative detection of PCT combined with CRP has certain value in prediction of postoperative incision infection.
OBJECTIVE To explore the value of procalcitonin(PCT)combined with C-reactive protein(CRP)in clinical diagnosis and prediction of postoperative incision infection in the puerpera undergoing lateral episiotomy.METHODS A total of 180 puerpera who were admitted to the obstetrics department of Third Affiliated Hospital of Zhengzhou University for labor from Jan 2017 to Dec 2017 were retrospectively enrolled in the study,the prevalence of postoperative incision infection of the lateral episiotomy puerpera was observed,the ecretions specimens were collected form the incision sites of the puerpera with infection,the pathogens were isolated,and the value of PCT and CRP in prediction of the postoperative infection was observed.RESULTS Of the 180 puerpera who underwent the lateral episiotomy,15 had incision infection,with the infection rate 8.33%.Totally 11 strains of pathogens were isolated from the local incision secretions,with the positive detection rate 73.33%(11/15);Escherichia coli was the predominant species of pathogen.The incidence rates of postoperative incision infection of the puerpera who were tested positive for PCT and CRP were respectively 23.52% and 15.15% before the lateral episiotomy,higher than those of the puerpera who were tested negative,and there were significant differences(all P<0.05).CONCLUSIONThe puerpera who are tested positive for PCT and CRP before the lateral episiotomy are at high risk of postoperative incision infection.The preoperative detection of PCT combined with CRP has certain value in prediction of postoperative incision infection.
引文
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[13]Kwon HY,Park HS.Episiotomy and the risk of severe perineal injuries among Korean women[J].J Matern Fetal Neonatal Med,2017,30(14):1745-1749.
[14]Huang Q T,Hang L L,Mei Z,et al.Maternal HCV infection is associated with intrauterine fetal growth disturbance[J].Medicine,2016,95(35):e4777.
[15]陈丽君,沈艳萍,陈丽贞.会阴侧切分娩产妇感染的相关因素分析及护理措施[J].中华全科医学,2013,11(7):1133-1134.
[16]Clark CE,Fay MP,Chico ME,et al.Maternal helminth infection is associated with higher infant immunoglobulin A titers to antigen in orally administered vaccines[J].J Infect Dis,2016,213(12):1996-2004.
[17]索瑞君.会阴切口感染原因分析及预防措施[J].中华医院感染学杂志,2013,23(16):3965-3966.
[18]Vale de Castro Monteiro M,Pereira GM,Aguiar RA,et al.Risk factors for severe obstetric perineal lacerations[J].Int Urogynecol J,2016,27(1):61-67.
[19]Steen M,Cummins B.How to alleviate perineal pain following an episiotomy[J].Nurs Stand,2016,30(31):34-37.
[20]祝志娟,陈蓉,郭叶情.会阴侧切术切口感染的危险因素分析[J].中华医院感染学杂志,2013,23(19):4722-4723.
[21]Dardamanis D,Larentzakis A.Predictive value of procalcitonin for bowel ischemia and necrosis in bowel obstruction[J].Surgery,2011,149(3):394-403.
[22]Desai H,Agrawal A.Pulmonary emergencies:pneumonia,acute respiratory distress syndrome,lung abscess,and empyema[J].Med Clin North Am,2012,96(6):1127-1148.
[23]Fodstad K,Staff AC,Laine K.Episiotomy preferences,indication,and classification--a survey among Nordic doctors[J].Acta Obstet Gynecol Scand,2016,95(5):587-595.
[24]Schietroma M,Cecilia EM,De Santis G,et al.Supplemental peri-operative oxygen and incision site infection after surgery for perforated peptic ulcer:a randomized,double-blind monocentric trial[J].Surg Infect(Larchmt),2016,17(1):106-113.
[25]Ginath S,Elyashiv O,Weiner E,et al.The optimal angle of the mediolateral episiotomy at crowning of the head during labor[J].Int Urogynecol J,2017,28(12):1795-1799.
[2]Kumar A,Sharma S,Kar P,et al.Impact of maternal nutrition in hepatitis E infection in pregnancy[J].Arch Gynecol Obstet,2017,296(5):885-895.
[3]赵丽,张海燕,王桂兰.产妇会阴侧切感染的病原学分析与抗菌药物优化治疗[J].中华医院感染学杂志,2015,25(4):917-919.
[4]Blomstrom A,Karlsson H,Gardner R,et al.Associations between maternal infection during pregnancy,childhood infections,and the risk of subsequent psychotic disorder--a Swedish cohort study of nearly 2million individuals[J].Schizophr Bull,2016,42(1):125-133.
[5]江莉,张志敏,郑九生,等.不同方法预防会阴侧切伤口感染的临床研究[J].中国妇幼保健,2014,29(34):5687-5689.
[6]中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.
[7]刘玉青,刘冰雁,张敏,等.预防产妇会阴侧切缝合术后切口感染的临床研究[J].中华医院感染学杂志,2015,25(17):4028-4029.
[8]李香娟,赵秀敏,李立峰,等.初产妇常规会阴侧切术和限制会阴侧切术的临床对照研究[J].中国医师杂志,2013,15(12):1676-1679.
[9]Nielsen PR,Meyer U,Mortensen PB.Individual and combined effects of maternal anemia and prenatal infection on risk for schizophrenia in offspring[J].Schizophr Res,2016,172(13):35-40.
[10]简萍,胡秋燕,李钟艳,等.感染可能性评分与降钙素原及C-反应蛋白在预测会阴侧切术后切口感染中的应用价值研究[J].中华医院感染学杂志,2017,27(20):4764-4767.
[11]Gossett DR,Gilchrist-Scott D,Wayne DB,et al.Simulation training for forceps-assisted vaginal delivery and rates of maternal perineal trauma[J].Obstet Gynecol,2016,128(3):429-435.
[12]尹洪花,卢艳霞,朱丙烟,等.产妇会阴侧切术后感染危险因素与预防措施[J].中华医院感染学杂志,2016,26(1):158-160.
[13]Kwon HY,Park HS.Episiotomy and the risk of severe perineal injuries among Korean women[J].J Matern Fetal Neonatal Med,2017,30(14):1745-1749.
[14]Huang Q T,Hang L L,Mei Z,et al.Maternal HCV infection is associated with intrauterine fetal growth disturbance[J].Medicine,2016,95(35):e4777.
[15]陈丽君,沈艳萍,陈丽贞.会阴侧切分娩产妇感染的相关因素分析及护理措施[J].中华全科医学,2013,11(7):1133-1134.
[16]Clark CE,Fay MP,Chico ME,et al.Maternal helminth infection is associated with higher infant immunoglobulin A titers to antigen in orally administered vaccines[J].J Infect Dis,2016,213(12):1996-2004.
[17]索瑞君.会阴切口感染原因分析及预防措施[J].中华医院感染学杂志,2013,23(16):3965-3966.
[18]Vale de Castro Monteiro M,Pereira GM,Aguiar RA,et al.Risk factors for severe obstetric perineal lacerations[J].Int Urogynecol J,2016,27(1):61-67.
[19]Steen M,Cummins B.How to alleviate perineal pain following an episiotomy[J].Nurs Stand,2016,30(31):34-37.
[20]祝志娟,陈蓉,郭叶情.会阴侧切术切口感染的危险因素分析[J].中华医院感染学杂志,2013,23(19):4722-4723.
[21]Dardamanis D,Larentzakis A.Predictive value of procalcitonin for bowel ischemia and necrosis in bowel obstruction[J].Surgery,2011,149(3):394-403.
[22]Desai H,Agrawal A.Pulmonary emergencies:pneumonia,acute respiratory distress syndrome,lung abscess,and empyema[J].Med Clin North Am,2012,96(6):1127-1148.
[23]Fodstad K,Staff AC,Laine K.Episiotomy preferences,indication,and classification--a survey among Nordic doctors[J].Acta Obstet Gynecol Scand,2016,95(5):587-595.
[24]Schietroma M,Cecilia EM,De Santis G,et al.Supplemental peri-operative oxygen and incision site infection after surgery for perforated peptic ulcer:a randomized,double-blind monocentric trial[J].Surg Infect(Larchmt),2016,17(1):106-113.
[25]Ginath S,Elyashiv O,Weiner E,et al.The optimal angle of the mediolateral episiotomy at crowning of the head during labor[J].Int Urogynecol J,2017,28(12):1795-1799.