外科手术部位感染目标性监测分析  

Targeted Supervision and Analysis of Surgical Site Infection

作　　者：郑媛[1] 张玲[2] 焦成元[1] 贾敏[1] 肖伟[1] 秦钰萍[1] 

机构地区：[1]中国人民解放军第三十七医院感染控制科,四川雅安625000 [2]中国人民解放军成都军区总医院感染控制科

出　　处：《华西医学》2014年第3期428-431,共4页West China Medical Journal

摘　　要：目的分析影响手术部位感染（SSI）的相关因素。方法对2012年7月1日-12月31日677例所有类别手术（不包括有植入物手术及心血管介入手术）患者术前根据外科手术切口污染情况进行切口类型分类，术后密切观察切口愈合情况。出院后1个月进行电话回访、定期来院复查，了解手术切口愈合情况，并按时填写统一表格。结果对677例手术患者进行随访，其中发生SSI12例，感染率为1．77％。污染及感染类切口SSI发生率（14．28％、30．76％）高于清洁及清洁．污染类切口（0．00％、0．59％），差异有统计学意义（P〈0．05）；术前住院时间≥4d者的SSI发生率（4．55％）显著高于术前住院时间为2～3d（0．60％）和≤1d者（0．68％），差异有统计学意义（P〈0．05）；外科手术部位感染目标和Ⅱ类切口围手术期预防性使用抗菌药物时间〉72h者SSI发生率（7．69％）高于术后用药时间≤48h者（0．00％）（P=-0．002）。结论缩短术前住院时间能降低SSI的发生率；围手术期长时间预防性应用抗菌药物不能有效预防术后感染，反而有增加感染的风险。Objective To analyze the relevant factors for surgical site infection. Methods A total of 677 cases of surgery in one hospital from July 1 to December 31 in 2012 were surveyed （not including implant and cardiac intervention surgeries）, which were divided into different groups according to the preoperative incision contamination level, and the postoperative healing of incisions were observed closely. After the patients were discharged, we investigated the situation of incisions by phone or periodic review, and forms were filled in on schedule. Results By follow-up evaluation of the 677 cases, the incisions in 12 cases were infected and the infection rate was 1.77%. Polluted and infected （14.28%, 30.76%） incisions caused more infection than the clean and clean-polluted incisions （0.00%, 0.59%）. The patients who stayed in hospital for 4 or more than 4 days before surgeries （infection rate was 4.55%） took more risk of infection than the patients whose preoperative time in hospital were 2-3 days （infection rate was 0.60%） and 1 or shorter than 1 day （0.68%）. Perioperative use of antibiotics for longer than 72 hours will increase the risk of incision infection than those within 48 hours （7.69%, 0.00%; P=0.002）. Conclusions Surgical site infection is related to the incision type. Shortening the preoperative in-hospital time will reduce the risk of infection. Long time use of antibiotics in perioperative period cannot prevent the postoperative infection effectively, but may increase the risk of infection.

关 键 词：外科手术部位感染 目标性监测 预防与控制 手术患者 

分 类 号：R619[医药卫生—外科学]