剖宫产手术患者麻醉对术后感染及炎性因子表达的影响分析  

Effect of anesthesia on postoperative infections and expression of inflammatory factors in cesarean section

作　　者：丁式敏[1] 丁香翠[2] 包春华[3] 陈秀清 周海慧[4] DING Shi-min;DING Xiang-cui;BAO Chun-hua;CHEN Xiu-qing;ZHOU Hai-hui(Maternal and Child Branch Hospital of Ruian People＇s Hospital of Zhejiang Province,Ruian,Zhejiang 325200,China)

机构地区：[1]浙江省瑞安市人民医院妇幼分院麻醉科,浙江瑞安325200 [2]浙江省瑞安市人民医院妇产科,浙江瑞安325200 [3]浙江省瑞安市人民医院红十字分院感管科,浙江瑞安325200 [4]浙江省瑞安市人民医院妇幼分院妇产科,浙江瑞安325200

出　　处：《中华医院感染学杂志》2018年第16期2526-2530,共5页Chinese Journal of Nosocomiology

基　　金：浙江省温州市医药卫生科学基金资助项目(2018B15)

摘　　要：目的探究剖宫产手术患者麻醉对术后感染及炎性因子的表达的影响分析。方法选择医院2015年2月-2017年1月收治的1 341例足月妊娠产妇为研究对象,观察剖宫产后患者医院感染情况,并进行耐药性分析及相关影响因素分析,并对术前及术后产妇的炎性因子的表达情况进行记录分析。结果 1 341例产妇剖宫产术后发生感染的共74例,感染率为5.52%;感染部位以切口感染为主,占43.24%;74例剖宫产术后感染患者血培养共培养出病原菌131株,其中革兰阳性菌72株占54.96%、革兰阴性菌59株占45.04%;多因素Logistic回归分析结果显示,胎膜早破、麻醉时间≥1h、术中出血量≥200 ml是导致产妇剖宫产术后发生感染的影响因素(P<0.05);产妇术前IL-6及IL-10水平分别为(5.14±1.25)ng/L及(33.14±7.36)ng/L,术后12h时IL-6及IL-10水平升高高峰,此后逐渐下降,在术后48h恢复降至(8.36±3.21)ng/L(P<0.05)。结论剖宫产产妇术后机体内炎症因子呈动态变化的趋势,并且术后发生感染与年龄、麻醉时间、胎膜早破、术中出血量密切相关,需要临床医生早期评估,及早针对高危患者采取针对性预防。OBJECTIVE To explore the effect of anesthesia on postoperative infections and expression of inflammatory factors in cesarean section.METHODS A total of 1341 pregnant women who were hospitalized from Feb.2015 to Jan.2017 were selected as study sujects.The nosocomial infections of the patients after cesarean section was observed,the drug resistance and the risk factors were analyzed,and the expression of the inflammatory factors before and after the operation was recorded and analyzed.RESULTS There were 74 cases of postoperative infections in maternal cesarean section,with the infection rate of 5.52%.The mian infection site was incision infection,accounting for 43.24%.A total of 131 strains of pathogenic bacteria were cultured in 74 patients with postoperative infection after cesarean section.Among them,72 strains（54.96%）were gram-positive bacteria and 59 strains（45.04%）were gram-negative bacteria.Multivariable logistic regression analysis showed that premature rupture of membranes,anesthesia for more than 1 hour,and intraoperative bleeding volume of more than 200 ml were risk factors of postoperative infections after cesarean section（P〈0.05）.The levels of IL-6 and IL-10 before operation were（5.14±1.25）ng/L and（33.14±7.36）ng/L,increased 12 hours after operation,and then gradually decreased,which reduced to（8.36±3.21）ng/L at 48 hours after surgery（P〈0.05）.CONCLUSIONThe postoperative inflammatory factors of cesarean section show a trend of dynamic change,and postoperative infection is closely related to age,anesthesia time,premature rupture of membranes,and intraoperative blood loss.Clinicians should take early evaluation,and take targeted prevention according to high-risk patients to.

关 键 词：剖宫产 麻醉 术后感染 炎性因子 

分 类 号：R619.3[医药卫生—外科学]