糖尿病产妇会阴切口感染病原菌与相关因素分析  

Pathogen characteristics and risk factors of perineal incision infection in parturients with diabetes mellitus

作　　者：刘开宏 郝洁倩 商蕊[1] 胡金凤[1] 赵丽雅 连方 LIU Kai-hong;HAO Jie-qian;SHANG Rui;HU Jin-feng;ZHAO Li-ya;LIAN Fang(Tianjin Hospital,Tianjin 300211,China)

机构地区：[1]天津市天津医院妇产科,天津300211 [2]山东中医药大学第一临床医学院,山东济南250355

出　　处：《中华医院感染学杂志》2018年第19期3000-3002,3006,共4页Chinese Journal of Nosocomiology

基　　金：山东省自然科学基金高校科研单位专项计划基金资助项目(ZR2009CL036)

摘　　要：目的探讨糖尿病产妇会阴切口感染的病原菌特点及相关因素。方法选择2013年4月-2017年1月于医院顺产并进行会阴侧切口的糖尿病产妇218例为研究对象,采集产妇术后会阴切口分泌物,进行病原菌鉴定。分析产妇年龄、体重指数(BMI)、孕周、产程、切口长度、住院时间、手术时间、手术出血量、发病季节、合并基础疾病、胎膜早破等临床资料,归纳糖尿病产妇会阴切口感染的相关因素。结果 218例糖尿病产妇会阴切口感染25例,感染率为11.47%,空腹血糖水平越高,糖尿病孕妇产后切口感染率越高(P<0.001);共培养分离病原菌31株,其中革兰阳性菌18株占58.06%,革兰阴性菌9株占29.03%,真菌4株占12.90%。年龄、阴道或肛门检查次数、第二产程、血糖控制水平、术后住院时间及术前生殖道感染是糖尿病产妇会阴切口感染的相关因素(P<0.05)。结论导致糖尿病产妇会阴切口感染的病原菌以革兰阳性菌为主,依据感染病原菌与相关因素进行综合干预,对于降低其切口感染率和提高产妇预后有着重要意义。OBJECTIVE To investigate the characteristics and related factors of pathogenic bacteria in diabetic parturients with perineal wound infection.METHODS A total of 218 diabetic parturients who underwent a perineal incision in the hospital from Apr.2013 to Jan.2017 were enrolled.The postpartum perineal incision secretions were collected and the pathogens were identified.Clinical data such as maternal age,body mass index（BMI）,gestational age,labor,length of incision,hospitalization time,operation time,surgical bleeding volume,disease season,combined basic disease,and premature rupture of membranes were analyzed,and the risk factors for perineal wound infection in diabetic parturients were summarized.RESULTS Twenty-five cases out of the 126 cases of diabetic parturients were found with perineal incision infection,and the infection rate was 11.47%.The higher the fasting blood glucose level,the higher the postpartum incision infection rate of parturients with diabetes（P 〈0.001）.31 strains of pathogens were isolated from co-culture,of which there were 18 strains of gram-positive bacteria accounting for 58.06%,9 strains of gram-negative bacteria accounting for 29.03%,and 4 strains of fungi accounting for 12.90%.Age,vaginal or anal examination frequency,second stage of labor,blood glucose control level,postoperative hospital stay and preoperative genital tract infection were related factors of perineal wound infection in parturients with diabetes（P〈0.05）.CONCLUSION Gram-positive bacteria are the main pathogens causing infection in diabetic parturients with perineal incision.Proper comprehensive intervention based on the pathogens and infection-related factors is of important significance for reducing the infection rate of incision and improve maternal prognosis.

关 键 词：糖尿病产妇 会阴切口 感染 病原菌 相关因素 

分 类 号：R587.1[医药卫生—内分泌]