2018—2020年中国结直肠术后手术部位感染现状研究  

Surgical site infection after colorectal surgery in China from 2018 to 2020

作　　者：吴秀文 张旭飞 阳怡羽 康佳琪 王培戈[3] 王道荣 李乐平 刘雯静[6] 任建安 Wu Xiuwen;Zhang Xufei;Yang Yiyu;Kang Jiaqi;Wang Peige;Wang Daorong;Li Leping;Liu Wenjing;Ren Jianan(Research Institute of General Surgery,Jinling Hospital,Medical School of Nanjing University,Nanjing 210002,China;Research Institute of General Surgery,Jinling Hospital,the Affiliated Second Clinical Hospital,Medical School of Southeast University,Nanjing 210002,China;Department of Emergency Surgery,the Affiliated Hospital of Qingdao University,Qingdao 266000,China;Department of Gastrointestinal Surgery,Northern Jiangsu People's Hospital,Yangzhou 225001,China;Department of Gastrointestinal Surgery,Shandong Provincial Hospital Affiliated Shandong First Medical University,Jinan 250021,China;Department of General Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China)

机构地区：[1]南京大学医学院附属金陵医院东部战区总医院全军普通外科研究所,南京210002 [2]东南大学医学院第二临床学院东部战区总医院全军普通外科研究所,南京210002 [3]青岛大学附属医院急诊科,青岛266000 [4]苏北人民医院普通外科,扬州225001 [5]山东第一医科大学附属省立医院胃肠外科,济南250021 [6]中国医学科学院北京协和医学院北京协和医院基本外科,北京100730

出　　处：《中华胃肠外科杂志》2022年第9期804-811,共8页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金(82072223);江苏省重点研发计划(BE2022823);江苏省卫生健康委医学科研项目(M2020052)。

摘　　要：目的调查中国结直肠术后手术部位感染(SSI)的发生情况, 探讨其风险因素, 为我国结直肠术后SSI的防控提供参考依据。方法采用观察性研究方法, 基于国家手术部位感染监测网2018—2020年开展的多中心研究, 提取3年中所有接受结直肠手术患者的临床资料。共纳入全国50家医院收治的2 122例结直肠手术患者, 其中男性1 252例, 女性870例;中位年龄为63(16)岁;中位体质指数为23(4.58)kg/m2。收集患者的一般资料和围手术期相关临床数据, 排除未成年、孕妇或接受妇产科手术、接受泌尿系统手术、行腹膜后位手术和体表包块切除以及有补片等植入物的手术者。主要结局指标为结直肠术后30 d内SSI发生率, 次要结局指标为术后30 d内病死率、术后重症监护室(ICU)住院时间、术后总住院时间以及住院费用。依据是否发生感染, 将患者分为SSI组和非SSI组, 分析结直肠术后发生SSI的危险因素, 并针对开腹手术和腹腔镜(或机器人)手术后发生SSI的危险因素进行亚组分析。非正态分布的连续性变量以M(IQR)表示, 组间比较采用Mann-WhitneyU秩和检验;单因素分析采用χ2检验, 多因素分析采用Logistic回归模型。结果结直肠术后SSI发生率为5.6%(119/2 122);其中浅部切口感染占39.5%(47/119)、深部切口感染占20.2%(24/119)、器官(间隙)感染占40.3%(48/119)。与非SSI组比较, SSI组患者病死率更高[2.5%(3/119)比0.1%(3/2 003), χ2=22.400, P=0.003], ICU住院时间更长[0(1)d比0(0)d, U=131 339, P<0.001]、术后总住院时间更长[18.5(12.8)d比9.0(6.0)d, U=167 902, P<0.001]、住院费用更多[7.5(4.9)万元比6.0(3.1)万元, U=126 189, P<0.001], 差异均具有统计学意义(均P<0.05)。多因素分析结果显示:合并高血压(OR=1.782, 95%CI:1.173~2.709, P=0.007)、术前白蛋白<35 g/L(OR=1.680, 95%CI:1.089~2.592, P=0.019)、污染或感染切口(OR=1.993, 95%CI:1.076~3.689, P=0.028)、行急诊手术(OR=2.067, 95%CI:1.0Objective This study aims to survey the incidence of surgical site infection(SSI)in China and to analyze its risk factors,so as to prevent and control SSI after colorectal surgery.Methods An observative study was conducted.Based on a program of Chinese SSI Surveillance from 2018 to 2020,the clinical data of all adult patients undergoing colorectal surgery during this time period were extracted.These included demographic characteristics and perioperative clinical parameters.Minors,pregnant women,obstetric or gynecological surgery,urological system surgery,retroperitoneal surgery,resection of superficial soft tissue masses,and mesh or other implants were excluded.A total of 2122 patients undergoing colorectal surgery from 50 hospitals were included,including 1252 males and 870 females.The median age was 63(16)years and the median BMI was 23(4.58)kg/m2.The primary outcome was the incidence of SSI within 30 days after colorectal surgery.The secondary outcomes were mortality within 30 days postoperatively,length of ICU stays and postoperative hospital stays,and cost of hospitalization.Patients were divided into the SSI group and non-SSI group based on the occurrence of SSI.Multivariable logistic regression was performed to analyze risk factors of SSI after colorectal surgery,and subgroup analysis was conducted for open and laparoscopic surgery.Results The incidence of SSI after colorectal surgery was 5.6%(119/2122),including 47 cases(47/119,39.5%)with superficial incisional infections,24 cases(24/119,20.2%)with deep incisional infections,and 48 cases(48/119,40.3%)with organ/space infections.The occurrence of SSI significantly increased mortality[2.5%(3/119)vs.0.1%(3/2003),χ2=22.400,P=0.003],the length of ICU stay[0(1)day vs.0(0)day,U=131339,P<0.001],postoperative hospital stay[18.5(12.8)days vs.9.0(6.0)days,U=167902,P<0.001],and medical expenses[75000(49000)yuan vs.60000(31000)yuan,U=126189,P<0.001](P<0.05).Multivariate analysis revealed that hypertension(OR=1.782,95%CI:1.173-2.709,P=0.007),preoperative albumin level

关 键 词：手术部位感染 结直肠手术 危险因素 

分 类 号：R656[医药卫生—外科学]