腹部手术患者切口感染的病原菌特点及影响因素分析
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摘要
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.
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.
引文
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[12]Al-Niaimi AN,Ahmed M,Burish N,et al.Intensive postoperative glucose control reduces the surgical site infection rates in gynecologic oncology patients[J].Gynecol Oncol,2015,136(1):71-76.
[13]王芳.手术室护理干预对腹部切口感染及愈合情况的影响[J].中国预防医学杂志,2017,18(10):798-800.
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[2]刘才堂,李雪萍,郭耀军,等.不同麻醉方式对老年患者上腹部手术肺部感染的影响[J].河北医学,2017,23(1):119-122.
[3]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.
[4]叶应妩,王毓三,申子瑜.全国临床检验操作规程[M].3版.南京:东南大学出版社,2006:11.
[5]沈黎黎.手术室细节护理管理预防腹部手术切口感染的效果分析[J].实用临床医药杂志,2016,20(12):85-87.
[6]Meagher H,Clarke MM,Grace PA.Conservative management of mesh-site infection in hernia repair surgery:a case series[J].Hernia,2015,19(2):231-237.
[7]Hsu CD,Cohn I,Caban R.Reduction and sustainability of cesarean section surgical site infection:an evidence-based innovative and multidisciplinary quality improvement intervention bundle program[J].Am J Infect Control,2016,44(11):1315-1320.
[8]Aga E,Keinan-Boker L,Eithan A,et al.Surgical site infections after abdominal surgery:incidence and risk factors a prospective cohort study[J].Infect Dis(Lond),2015,47(11):761-767.
[9]林佩贤,黄宝添,王清江,等.腹部手术部位感染危险因素的病例对照研究[J].中华疾病控制杂志,2015,19(11):1145-1148.
[10]Tiret E.398:Nasal carriage of Staphylococcus aureus in patients undergoing cesarean section and surgical site infection:aprospective randomized trial[J].Am J Obstet Gynecol,2015,212(1):S206-S207.
[11]赵国良,张在保.手术患者发生切口感染的手术室相关因素分析及护理对策[J].基因组学与应用生物学,2016,35(8):1912-1915.
[12]Al-Niaimi AN,Ahmed M,Burish N,et al.Intensive postoperative glucose control reduces the surgical site infection rates in gynecologic oncology patients[J].Gynecol Oncol,2015,136(1):71-76.
[13]王芳.手术室护理干预对腹部切口感染及愈合情况的影响[J].中国预防医学杂志,2017,18(10):798-800.
[14]李妍,李娜.剖宫产切口感染的高危因素分析及预防策略[J].中国妇幼保健,2017,32(21):5195-5198.