腹部手术后手术部位感染的影响因素分析  

Influencing factors of surgical site infection after abdominal surgery

作　　者：段飞 李学民 段希斌 李亚平 杨国威 秦红英 任建安 郜永顺[4] 赵杰[5] 李朝辉[6] 刘现立[7] 吴刚[8] Duan Fei;Li Xuemin;Duan Xibin;Li Yaping;Yang Guowei;Qin Hongying;Ren Jian'an;Hao Yongshun;Zhao Jie;Li Chaohui;Liu Xianli;Wu Gang(Department of Hepatopancreatobiliary Surgery,Zhengzhou Central Hospital Affiliated to Zhengzhou University,Zhengzhou 450007,China;Department of Infection Prevention and Control,Zhengzhou Central Hospital Affiliated to Zhengzhou University,Zhengzhou 450007,China;Research Institute of General Surgery,East War Zone Hospital of PLA,Nanjing 210002,China;Department of Gastrointestinal Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of General Surgery,Shangqiu First People's Hospital,Shangqiu 476005,Henan Province,China;Department of Gastrointestinal Surgery,Luoyang Central Hospital,Luoyang 471099,Henan Province,China;Department of Gastrointestinal Surgery,the First Affiliated Hospital of Henan University of Science and Technology,Luoyang 471003,Henan Province,China;Department of Gastrointestinal Surgery,Henan Provincial People's Hospital,Zhengzhou 450003,China)

机构地区：[1]郑州大学附属郑州中心医院肝胆胰外科,郑州450007 [2]郑州大学附属郑州中心医院感染预防控制科,郑州450007 [3]解放军东部战区总医院普通外科研究所,南京210002 [4]郑州大学第一附属医院胃肠外科,郑州450052 [5]商丘市第一人民医院普通外科,商丘476005 [6]洛阳市中心医院胃肠外科,洛阳471099 [7]河南科技大学第一附属医院胃肠外科,洛阳471003 [8]河南省人民医院胃肠外科,郑州450003

出　　处：《中华消化外科杂志》2022年第12期1539-1546,共8页Chinese Journal of Digestive Surgery

基　　金：河南省科技攻关项目(182102311137)。

摘　　要：目的探讨腹部手术后手术部位感染(SSI)的影响因素。方法采用回顾性横断面研究方法。收集2020年6月1-30日我国6家医学中心收治的567例(郑州大学附属郑州中心医院445例、郑州大学第一附属医院54例、商丘市第一人民医院49例、洛阳市中心医院10例、河南科技大学第一附属医院5例、河南省人民医院4例)行腹部手术患者的临床资料;男284例, 女283例;年龄为(51±18)岁。观察指标:(1)术后SSI发生情况。(2)术后发生SSI的影响因素分析。采用门诊和电话方式进行随访, 了解患者术后SSI发生情况, 无植入物患者随访时间为术后30 d、有植入物患者随访至术后1年。正态分布分布的计量资料以x±s表示, 组间比较采用独立样本t检验;偏态分布的计量资料以M(范围)表示, 组间比较采用Mann-WhitneyU检验。计数资料以绝对数或百分比表示, 组间比较采用χ^(2)检验或Fisher确切概率法。单因素分析采用对应的统计学检验方法。多因素分析采用Logistic逐步回归模型前进法。结果 (1)术后SSI发生情况。567例患者术后均按计划获得随访, 术后发生SSI 27例, 其中浅表切口感染、深部切口感染、器官和(或)腔隙感染各9例。27例发生SSI患者中, 分泌物及脓液细菌培养阳性18例, 病原菌依次为大肠埃希菌8例, 肺炎克雷伯菌6例, 屎肠球菌3例, 铜绿假单胞菌1例。(2)术后发生SSI的影响因素分析。单因素分析结果显示:年龄、术前血红蛋白、术前白蛋白、术前空腹血糖、术前肠道准备、手术类型、手术部位、手术切口类型、手术时间、入住重症监护室(ICU)时间、术后住院时间、总住院时间、住院费用是腹部手术患者术后发生SSI的相关因素(χ^(2)=40.12, Z=-4.22、-2.21、-4.75, χ^(2)=7.07、16.43、38.06、17.50, Z=-4.43、-4.42、-7.14、-7.15、-5.90, P<0.05);美国麻醉医师协会分级、术前口服抗菌药物、手术方式、术后入住重症监�Objective To investigate the influencing factors of surgical site infection(SSI)after abdominal surgery.Methods The retrospective cross-sectional study was conducted.The clinical data of 567 patients undergoing abdominal surgery in 6 medical centers,including 445 cases in the Zhengzhou Central Hospital Affiliated to Zhengzhou University,54 cases in the the First Affiliated Hospital of Zhengzhou University,49 cases in the Shangqiu First People's Hospital,10 cases in the Luoyang Central Hospital,5 cases in the First Affiliated Hospital of Henan University of Science and Technology and 4 cases in the Henan Provincial People's Hospital,from June 1 to June 30,2020 were collected.There were 284 males and 283 females,aged(51±18)years.Observation indicators:(1)incidence of SSI after surgery;(2)influencing factors of SSI.Follow-up was conducted using outpatient examination and telephone interview to detect the incidence of SSI.Patients without implant were followed up within postoperative 30 days,and patients with implant were followed up within postoperative 1 year.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was conducted using the independent sample t test.Measurement data with skewed distribution were represented as M(range),and comparison between groups was conducted using the Mann‐Whitney U test.Count data were described as absolute numbers or percentages,and comparison between groups was performed using the chi‐square test or Fisher exact probability.Univariate analysis was performed using the corresponding statistical methods.Multivariate analysis was performed using the Logistic stepwise regression model advance method.Results(1)Incidence of SSI after surgery.All the 567 patients were followed up after surgery as planned.There were 27 cases with SSI after surgery including 9 cases with superficial incision infection,9 cases with deep incision infection,9 cases with organ/gap infection.Of the 27 cases with SSI after surgery,18 cases with positive results

关 键 词：感染 手术部位感染 腹部手术 危险因素 横断面研究 

分 类 号：R656[医药卫生—外科学]