成人体外循环心脏术后手术部位感染的危险因素分析  

Risk factors of surgical site infection in adult patients after cardiopulmonary bypass surgery

作　　者：尤颢[1] 廖崇先[1] 杨谦[1] 单忠贵[1] 赵霞[1] 林智[1] 强海峰[1] 郭宏伟[1] 

机构地区：[1]厦门大学附属中山医院心脏外科,福建厦门361004

出　　处：《中华医院感染学杂志》2011年第5期894-896,共3页Chinese Journal of Nosocomiology

摘　　要：目的分析成人体外循环心脏术后手术部位感染(SSI)发生的危险因素。方法对心脏外科2001年1月-2009年6月体外循环心脏直视术后1743例成年患者进行分析,根据SSI发生与否将其分为SSI组及对照组,对两组患者的临床资料中SSI的潜在危险因素进行单因素分析和logistic多因素回归分析。结果心脏直视术后SSI总发病率2.87%,SSI组平均住院时间及30 d再入院率高于对照组;单因素分析发现术前心功能NYHA≥Ⅲ级、合并糖尿病、肾功能不全、冠脉手术、术前血浆白蛋白低、体外循环时间、手术时间、术后血液制品的用量、切口缝合方法、二次开胸止血、术后12 h血糖平均值及ICU入住时间与SSI的发生有关(P<0.05或0.01);logistic多因素回归分析显示,冠状动脉手术(OR=4.724,P=0.014)、手术时间(OR=1.008,P=0.024)和术后12 h血糖平均值(OR=1.023,P=0.000)是SSI发生的危险因素,而切口皮下间断缝合(OR=0.326,P=0.002)可减少SSI的发生;27例送检标本共培养出病原菌22株,其中革兰阳性菌16株,占72.7%,革兰阴性菌6株,占27.3%。结论冠状动脉手术、心脏手术时间长及术后高血糖是体外循环心脏术后SSI发生的危险因素,改进缝合方法可减少SSI的发生。OBJECTIVE To analyze the risk factors of surgical site infection （SSI） in adult patients undergoing cardiac surgery with cardiopulmonary bypass （CPB）. METHODS A total of 1743 patients who had major heart surgery at our cardiac surgical department between Jan 2001 and Jun 2009 were included in this study. The patients were assigned into SSI group （n= 50） and control group （n=1693）. Clinical characteristics of two groups were collected and compared. Univariate regression and multivariate logistic regression analysis were used to identify the risk factors of the development of SSI. RESULTS The overall incidence of SSI was 2.87%. Compared to the control group, the SSI group had longer length of postoperative stay and higher rates of hospital readmission. Univariate risk factors included： NYHA≥Ⅲ, diabetes mellitus, renal insufficiency, low level of plasma albumin, coronary artery bypass surgery, duration of eardiopulmonary bypass time, operation time, blood products usage, the methods of incision suture, re-operation for stopping bleeding, the mean blood sugar level within 12 hours after operation, the duration of stay in CSICU （P〈0.01 or 0.05）. Four variables were found to be significantly related to the development of SSI by multivariate analysis： coronary artery bypass grafts operation （odds ratio [OR], 4. 724, P=0. 014, operation time （OR=1. 008, P=0. 024）, and the mean blood sugar level within 12 hours after operation （OR=1. 023, P= 0. 000）. 22 pathogens were obtained by 27 culture samples in 50 patients. There were 16 （72.7%） cases of gram positive cocci and 6 cases （27.3%） Gram negative bacilli. CONCLUSION This study shows that the coronary artery bypass operation, long operation time and high level of blood sugar the are risk factors most likely associated with SSI development. Improving suture method can reduce the morbidity of SSI.

关 键 词：手术部位感染 心脏手术 体外循环 危险因素 多因素回归分析 

分 类 号：R181.32[医药卫生—流行病学]