老年患者手术部位感染的危险因素分析  

Analysis of risk factors for the postoperative surgical site infection in elderly patients

作　　者：韩冰[1] 张晟 张智 俞瑞东[1] 宋晓华[1] 吴志雄[1] Han Bing;Zhang Sheng;Zhang Zhi;Yu Ruidong;Song Xiaohua;Wu Zhixiong(Department of Critical Care Medicine,Huadong Hospital Affiliated to Fudan University,Shanghai,200040,P.R.China;Department of Critical Care Medicine,Ruijin Hospital Affiliated to Medical College of Shanghai Jiaotong University,Shanghai,200025,P.R.China)

机构地区：[1]复旦大学附属华东医院重症医学科,上海200040 [2]上海交通大学医学院附属瑞金医院重症医学科,上海200025

出　　处：《老年医学与保健》2022年第5期1142-1146,共5页Geriatrics & Health Care

摘　　要：目的 探讨老年患者发生手术部位感染(SSI)的危险因素。方法 回顾性分析2016年1月—2019年1月在复旦大学附属华东医院重症医学科接受治疗的204例外科术后老年患者的临床资料,根据是否发生SSI分为SSI组(n=35)和非SSI组(n=169)。收集患者的性别、年龄、体重、身高、体质量指数(BMI)、基础疾病、手术时间、手术部位、麻醉类型、美国麻醉医师协会(ASA)分级、急性生理学及慢性健康状况评价(APACHEⅡ)、序贯器官衰竭评价(SOFA)以及慢性肾功能不全等临床资料。对比术前及术后第1、 3、 5天的血红蛋白、总胆红素(TB)、血小板、白蛋白、肌酐清除率、血肌酐和脑利尿钠肽(BNP)。分析老年患者SSI的危险因素。结果 与非SSI组比较,SSI组年龄较小、 BMI较小,体重较轻,手术时间较长,APACHEⅡ和SOFA评分较高,差异有统计学意义(P<0.05)。时间因素对血红蛋白、白蛋白、血肌酐、肌酐清除率和BNP的主效应差异有统计学意义(P<0.05)。多因素logistic回归分析显示,高APACHEⅡ评分、术后第1天TB升高及术后第1天BNP升高是老年患者发生SSI的独立危险因素,而低体重为SSI的保护因素。SSI预测模型的受试者操作特征曲线下面积为0.792,敏感性为77.13%,特异性为81.12%。结论 高APACHEⅡ评分、术后第1天TB和BNP水平升高可能是老年患者SSI的危险因素。Objective To investigate the risk factors of surgical site infection(SSI) in elderly patients.Methods The clinical data of 204 elderly patients after surgery who were treated in Department of Critical Care Medicine,Huadong Hospital Affiliated to Fudan University from January 2016 to January 2019 were retrospectively analyzed.They were divided into SSI group(n=35) and non-SSI group(n=169) according to whether SSI occurred.The clinical data such as gender,age,weight,height,body mass index(BMI),basic disease,operation time,operation site,type of anesthesia,American Society of Anesthesiologists(ASA) classification,Acute Physiology and Chronic Health Evaluation(APACHE Ⅱ) score,Sequential Organ Failure Assessment(SOFA) score and chronic renal insufficiency were collected.Hemoglobin,total bilirubin(TB),platelet,albumin,creatinine clearance rate,serum creatinine and brain natriuretic peptide(BNP) before and 1,3,5 days after operation were compared.The risk factors of SSI in elderly patients were analyzed.Results Compared with the non-SSI group,the SSI group had younger age,lower BMI,lower body weight,longer operation time,higher APACHE Ⅱ and SOFA scores,and the differences were statistically significant(P<0.05).There were significant differences in hemoglobin,albumin,serum creatinine,creatinine clearance rate and BNP between the two groups at different time points(P<0.05).Multivariate logistic regression analysis showed that high APACHE Ⅱ score,increased TB on the 1 st postoperative day,and increased BNP on the 1 st postoperative day were independent risk factors for SSI in elderly patients,while low body weight was a protective factor for SSI.The area under the receiver operating characteristic curve of the SSI prediction model was 0.792,the sensitivity was 77.13%,and the specificity was 81.12%.Conclusion High APACHE Ⅱ score,increased TB and BNP levels on the first day after operation may be risk factors for SSI in elderly patients.

关 键 词：老年 手术部位感染 危险因素 

分 类 号：R619.3[医药卫生—外科学]