急诊肠梗阻术后切口感染的危险因素分析
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摘要
目的分析急诊肠梗阻术后切口感染的危险因素。方法选择2014年1月至2017年12月于成都市公共卫生临床医疗中心外二科进行急诊手术治疗的肠梗阻患者540例,依据是否发生术后切口感染分为感染组(n=40)与未感染组(n=500),检测感染组切口感染病菌,比较两组一般资料,并进行Logistic多因素分析。结果两组年龄、年龄≥65岁、病程、BMI、BMI≥28kg/m~2、手术时间、手术时间≥120min、住院时间、夏季、手术分级4级、切口类型、是否输血、是否合理预防用药、糖尿病等差异均有统计学意义(P<0.05)。感染组感染切口共检出病原菌140株,检出比例最高为大肠埃希菌(32.14%)。Logistic多因素分析结果表明,年龄≥65岁、病程、BMI≥28kg/m~2、手术时间≥120min、夏季手术、手术分级4级、切口类型、未输血、未合理预防用药、糖尿病等均为导致术后切口感染发生的危险因素。结论年龄≥65岁、病程、BMI≥28kg/m~2、手术时间≥120min、夏季手术、手术分级4级、切口类型、未输血、未合理预防用药、糖尿病等均为导致术后切口感染发生的危险因素。
Objective To analyze the risk factors of postoperative incision infection in emergency intestinal obstruction.Methods A total of 540 patients with intestinal obstruction treated with emergency operations in Public Health Clinical Medical Center of Chengdu from January of 2014 to December of 2017 were selected and divided into the infection group(n=40)and non-infection group(n=500)according to the occurrence of postoperative incision infection.The pathogenic bacteria of the incision infection in the infection group were detected.The general data of the two groups were compared and the logistic multivariate analysis was carried out.Results There were significant differences between the two groups in age,age of no less than 65,course of disease,BMI,BMI of no less than 28 kg/m~2,operation time,operation time of no less than 120 min,hospitalization time,operation in summer,operation of Grade 4,incision type,blood transfusion,reasonable preventive medication and diabetes(P<0.05).A total of 140 strains of pathogenic bacteria were detected in the infected incisions of infection group,and Escherichia coli was detected with the highest detection rate(32.14%).The results of logistic multivariate analysis showed that age of no less than 65,course of disease,BMI of no less than 28 kg/m~2,operation time of no less than 120 min,operation in summer,operation of Grade 4,incision type,no blood transfusion,no reasonable preventive medication,and diabetes are all the risk factors of the postoperative incision infection.Conclusion The risk factors of the postoperative incision infection involve age of no less than 65,course of disease,BMI of no less than 28 kg/m~2,operation time of no less than 120 min,operation in summer,operation of Grade 4,incision type,no blood transfusion,no reasonable preventive medication,and diabetes.
Objective To analyze the risk factors of postoperative incision infection in emergency intestinal obstruction.Methods A total of 540 patients with intestinal obstruction treated with emergency operations in Public Health Clinical Medical Center of Chengdu from January of 2014 to December of 2017 were selected and divided into the infection group(n=40)and non-infection group(n=500)according to the occurrence of postoperative incision infection.The pathogenic bacteria of the incision infection in the infection group were detected.The general data of the two groups were compared and the logistic multivariate analysis was carried out.Results There were significant differences between the two groups in age,age of no less than 65,course of disease,BMI,BMI of no less than 28 kg/m~2,operation time,operation time of no less than 120 min,hospitalization time,operation in summer,operation of Grade 4,incision type,blood transfusion,reasonable preventive medication and diabetes(P<0.05).A total of 140 strains of pathogenic bacteria were detected in the infected incisions of infection group,and Escherichia coli was detected with the highest detection rate(32.14%).The results of logistic multivariate analysis showed that age of no less than 65,course of disease,BMI of no less than 28 kg/m~2,operation time of no less than 120 min,operation in summer,operation of Grade 4,incision type,no blood transfusion,no reasonable preventive medication,and diabetes are all the risk factors of the postoperative incision infection.Conclusion The risk factors of the postoperative incision infection involve age of no less than 65,course of disease,BMI of no less than 28 kg/m~2,operation time of no less than 120 min,operation in summer,operation of Grade 4,incision type,no blood transfusion,no reasonable preventive medication,and diabetes.
引文
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[19]Garraud O,Tissot J D.Linking transfusion and ecology is not so futile after all:A holistic reappraisal of transfusion and immunity[J].Transfus Clin Biol,2018,25(1):82-83.
[20]Aoude A,Aldebeyan S,Fortin M,et al.Prevalence and complications of postoperative transfusion for cervical fusion procedures in spine surgery:an analysis of 11,588patients from the american college of surgeons national surgical quality improvement program database[J].Asian Spine J,2017,11(6):880-891.
[21]Imperatori A,Nardecchia E,Dominioni L,et al.Surgical site infections after lung resection:A prospective study of risk factors in 1,091consecutive patients[J].J Thorac Dis,2017,9(9):3222-3231.
[2]Capela T,Sousa P,Caldeira A,et al.Intestinal obstruction of uncommon cause and point-of-care ultrasonography-where do we stand[J].GE Port J Gastroenterol,2018,25(1):38-41.
[3]Lauro A,Pinna A D,Tossani E,et al.Multimodal surgical approach for adult patients with chronic intestinal pseudoobstruction:clinical and psychosocial long-term outcomes[J].Transplant Proc,2018,50(1):226-233.
[4]Agarwal S K,Khan A A,Solan M,et al.Hip fracture surgery in mixed-use emergency theatres:Is the infection risk increased?A retrospective matched cohort study[J].Ann RColl Surg Engl,2017,99(8):641-644.
[5]Bankole A O,Osinowo A O,Adesanya A A.Predictive factors of management outcome in adult patients with mechanical intestinal obstruction[J].Niger Postgrad Med J,2017,24(4):217-223.
[6]程孝惠,吴永友,殷婧雯,等.术前模拟训练指导降低肠梗阻患者术后感染的临床研究[J].中华医院感染学杂志,2015,25(4):901-903.
[7]Shaffer V O,Baptiste C D,Liu Y,et al.Improving quality of surgical care and outcomes:Factors impacting surgical site infection after colorectal resection[J].Am Surg,2014,80(8):759-763.
[8]于永洋,黄耘,刘昭晖,等.阿莫西林克拉维酸钾对急诊肠梗阻手术减张缝合患者术后感染及炎症指标的影响[J].中国生化药物杂志,2016,36(11):53-55.
[9]何铂玲,林新山,HE Bo-ling,等.老年急性肠梗阻病因及手术时机对术后并发症的影响[J].临床普外科电子杂志,2016,4(4):15-18.
[10]孙晓林,宋展,于桂青,等.普外科患者术后切口感染病原菌与耐药性分析[J].中华医院感染学杂志,2015,25(6):1262-1264.
[11]黄新玲,郑丽英,何文英,等.肥胖对结直肠癌手术部位感染的影响[J].中国感染控制杂志,2015,14(12):837-839.
[12]Boyle K K,Duquin T R.Antibiotic prophylaxis and prevention of surgical Site infection in shoulder and elbow surgery[J].Orthop Clin North Am,2018,49(2):241-256.
[13]Sagawa M,Yoshimatsu K,Yokomizo H,et al.Worse preoperative status based on inflammation and host immunity is a risk factor for surgical Site infections in colorectal cancer surgery[J].J Nippon Med Sch,2017,84(5):224-230.
[14]李骥波,李啸波.老年术后患者发生医院感染的调查[J].中华医院感染学杂志,2013,23(2):480.
[15]Aravindhan V,Anand G.Cell type-specific immunomodulation induced by helminthes:effect on metainflammation,insulin resistance and type-2diabetes[J].Am J Trop Med Hyg,2017,97(6):1650-1661.
[16]Zhang Z,Adappa N D,Lautenbach E,et al.The effect of diabetes mellitus on chronic rhinosinusitis and sinus surgery outcome[J].Int Forum Allergy Rhinol,2014,4(4):315-320.
[17]Barry J Y,McCrary H C,Kent S,et al.The Triple Aim and its implications on the management of chronic rhinosinusitis[J].Am J Rhinol Allergy,2016,30(5):344-350.
[18]Nguyen D B,Gupta N,Abou-Daoud A,et al.Apolymicrobial outbreak of surgical site infections following cardiac surgery at a community hospital in Florida,2011-2012[J].Am J Infect Control,2014,42(4):432-435.
[19]Garraud O,Tissot J D.Linking transfusion and ecology is not so futile after all:A holistic reappraisal of transfusion and immunity[J].Transfus Clin Biol,2018,25(1):82-83.
[20]Aoude A,Aldebeyan S,Fortin M,et al.Prevalence and complications of postoperative transfusion for cervical fusion procedures in spine surgery:an analysis of 11,588patients from the american college of surgeons national surgical quality improvement program database[J].Asian Spine J,2017,11(6):880-891.
[21]Imperatori A,Nardecchia E,Dominioni L,et al.Surgical site infections after lung resection:A prospective study of risk factors in 1,091consecutive patients[J].J Thorac Dis,2017,9(9):3222-3231.