剖宫产术后手术部位感染的影响因素分析-东南大学学报医学版

剖宫产术后手术部位感染的影响因素分析

单位：南京市鼓楼医院妇产科, 江苏南京 210000

分类号：R719.8; R714.46

出版年·卷·期（页码）：2023·42·第三期（457-461）

摘要：

目的: 探讨剖宫产术后导致手术部位感染的影响因素。方法: 收集2021年1月18日至2021年4月18日于我院行剖宫产手术的555例孕妇的年龄、孕周、孕前BMI、试管婴儿、双胎、剖宫产次数、胎膜早破、血压、血糖、白色念珠菌感染情况、B族链球菌感染情况、手术类型、术后出血、产前及产程中发热、急性绒毛膜羊膜炎、抗生素使用情况和剖宫产术后切口愈合情况。电话随访所有患者至少至产后42 d,发生手术部位感染导致切口愈合不良相应延长随访时间至感染痊愈切口完全愈合,根据切口感染情况将产妇分为剖宫产手术部位感染组和对照组,使用Logistic回归分析筛选术后发生剖宫产手术部位感染的影响因素。结果: 在纳入的555例孕产妇中,有完整临床及随访资料551例,4例失访,随诊率为99.3%,44例术后切口感染,感染率8.0%。(1)孕妇妊娠合并白色念珠菌感染、剖宫产次数≥3次、手术类型、抗生素的使用比较,差异均具有统计学意义(均P<0.05)。(2)多因素分析后,妊娠合并白色念珠菌感染OR=11.13,95%CI为1.72~72.15,P=0.001;剖宫产次数≥3次OR=6.10,95%CI为1.94~19.15,P=0.002;胎膜早破OR=2.35,95%CI为1.01~5.52,P=0.049;抗生素的使用OR=3.74,95%CI为1.46~9.44,P=0.005。结论: 尽早识别影响因素,将这些独立的影响因素应纳入剖宫产术后手术部位感染的预防和监测中,对降低术后切口感染的发生率和病死率至关重要。

Objective: To investigate the influence factors of surgical site infection after cesarean section. Methods: The data of 555 women who under cesarean section during the period from January 18, 2021 to April 18,2021 were collected, including age, gestational weeks, pre-pregnancy BMI, test tube baby, twins, number of cesarean delivery, premature rupture of fetal membranes, blood pressure, blood glucose, situation of candida albicans infection,group B streptococcus infection, type of surgery, postoperative bleeding, antenatal and labor fever, acute chorioamnionitis, antibiotic use and wound healing after cesarean section. Telephone follow-up of all patients was at least 42 days after cesarean section, time should be extended until the incision was completely healed for poor healing of incision infection. According to the situation of incision infection, the lying-in women were divided into the cesarean section surgical site infection group and the control group. Logistic regression analysis was used to screen the influencing factors of postoperative cesarean section surgical site infection. Results: Among 555 pregnant and lying-in women,551 cases had complete clinical and follow-up data, 4 cases were lost to follow-up, the follow-up rate was 99.3%, 44 cases had postoperative incision infection, the infection rate was 8.0%.(1) There were statistically significant differences in pregnancy, including candida albicans infection, cesarean section times of 3 or more, type of operation and use of antibiotics(P<0.05).(2) After multi-factor analysis, pregnancy with candida albicans infection OR=11.13, 95%CI 1.72-72.15,P=0.001; cesarean section times of 3 or more OR=6.10, 95%CI 1.94-19.15,P=0.002; premature rupture of membranes OR=2.35, 95%CI 1.01-5.52, P=0.049; use of antibiotics OR=3.74, 95%CI 1.46-9.44, P=0.005. Conclusion: The influencing factors should be early identified, these independent risk factors should be incorporated into approaches for the prevention and surveillance of surgical site infection after cesarean section, which are essential to reduce the morbidity and mortality of postoperative incision infection.

参考文献：

[1] BETRÁN A P,MERIALDI M,LAUER J A,et al.Rates of caesarean section:analysis of global,regional and national estimates[J].Paediatr Perinat Epidemiol,2007,21(2):98-113.
[2] OLSEN M A,BUTLER A M,WILLERS D M,et al.Risk factors for surgical site infection after low transverse cesarean section[J].Infect Control Hosp Epidemiol,2008,29(6):477-484.
[3] 郑小玲,胡莉娜,孙亚青,等.剖宫产术后切口感染病原学特点及其危险因素分析[J].中华医院感染学杂志,2017,27(21):4978.
[4] SCHOLZ R,SMITH B A,ADAMS M G,et al.A multifaceted surgical site infection prevention bundle for cesarean delivery[J].Am J Perinatol,2021,38(7):690-697.
[5] SALIM R,BRAVERMAN M,TEITLER N,et al.Risk factors for infection following cesarean delivery:an interventional study[J].J MaternFetal Neonatal Med,2012,25(12):2708-2712.
[6] AWAD S S.Adherence to surgical care improvement project measures and post-operative surgical site infections[J].Surg Infect(Larchmt),2012,13(4):234-237.
[7] 乐杰.妇产科学[M].5 版,北京:人民卫生出版社,2008:301-308.
[8] 刘晓娟,范爱萍,薛凤霞.《2015年美国疾病控制和预防中心关于盆腔炎性疾病的诊治规范》解读[J].国际妇产科学杂志,2015,42(6):674-675.
[9] HORAN T C,GAYNES R P,MARTONE W J,et al.CDC definitions of noscomial surgical site infections,1992:a modification of CDC definitions of surgical wound infections[J].Am J Infect Control,1992,13(10):606-608.
[10] KOROL E,JOHNSTON K,WASER N,et al.A systematic review of risk factors associated with surgical site infections among surgical patients[J].PLoS One,2013,8(12):1-2.
[11] GILSTRAP L C,CUNNINGHAM F G.The bacterial pathogenesis of infection following cesarean section[J].Obstet Gynecol,1979,53(5):545-549.
[12] DLAMINI L D,SEKIKUBO M,TUMUKUNDE J,et al.Antibiotic prophylaxis for caesarean section at a Ugandan hospital:a randomised clinical trial evaluating the effect of administration time on the incidence of postoperative infections[J].BMC Pregnancy Childbirth,2015,15(91):5-6.
[13] FITZWATER J L,TITA A T.Prevention and management of cesarean wound infection[J].Obstet Gynecol Clin North Am,2014,41(4):671-689.
[14] 陈娟娟,陈敦金.剖宫产手术并发子宫切口感染[J].中国实用妇科与产科杂志,2019(2):5.
[15] KILLIAN C A,GRAFFUNDER E M,VINCIGUERRA T J,et al.Risk factors forsurgical-site infections following cesareansection[J].Infect Control Hosp Epidemiol,2001,22:613-617.
[16] SCHNEID-KOFMAN N,SHEINER E,LEVY A,et al.Risk factors for wound infection following cesarean deliveries[J].Int J Gynaecol Obstet,2005,90:10-15.
[17] TRAN T S,JAMULITRAT S,CHONGSUVIVATWONG V,et al.Risk factors for postcesarean surgical site infection[J].Obstet Gynecol,2000,95:367-371.
[18] MANGRAM A J,HORAN T C,PEARSON M L,et al.Guideline for prevention of surgical site infection,1999.Hospital Infection Control Practices Advisory Committee[J].Infect Control Hosp Epidemiol,1999,20:250-278.
[19] NYSTROM P O,JONSTAM A,HOJER H,et al.Incisional infection after colorectal surgery in obese patients[J].Acta Chir Scand,1987,153:225-227.
[20] ALEXANDER J K,DENNIS E W,SMITH W G,et al.Blood volume,cardiac output,and distribution of systemic blood flow in extreme obesity[J].Cardiovasc Res Cent Bull,1962,1:39-44.
[21] ROY M C.Modern approaches to preventing surgical site infections[M]//WENZEL R P.Prevention and control of nosocomial infections.Philadelphia:Lippincott Williams & Wilkins,2003:370-384.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录