基于风险分级的经腹直肠癌切除术后器官腔隙感染防控效果  

Effects of measures based on risk classification on prevention and control of postoperative organ space infection in patients undergoing transabdominal Dixon surgery

作　　者：贾会学[1] 孙尚念 李六亿[1] JIA Hui-xue;SUN Shang-nian;LI Liu-yi(Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院感染管理-疾病预防控制处,北京100034 [2]北京大学第一医院普通外科,北京100034

出　　处：《中华医院感染学杂志》2023年第2期300-304,共5页Chinese Journal of Nosocomiology

基　　金：北京大学第一医院科研种子基金项目(2019SF50)。

摘　　要：目的评估经腹直肠癌切除术(Dixon术)术后器官腔隙感染防控措施的效果。方法对2017-2018年北京大学第一医院收治的实施Dixon术的直肠癌患者(对照组)术后器官腔隙感染的危险因素进行调查,基于分析结果,建立风险分级评分系统,针对2019-2021年手术患者(研究组)进行目标性监测,对于中高风险患者给予精准关注,同时结合患者情况,与临床医生共同探讨行保护性造口的作用。比较对照组与研究组患者感染情况及保护性造口情况。结果与对照组比较,研究组中高风险分组患者比例差异无统计学意义,整体器官腔隙感染率从7.83%降至3.08%,差异有统计学意义(χ^(2)=12.116,P<0.001)。通过干预措施,研究组中高风险组患者整体感染率从29.23%降至4.72%(P<0.001),并与低风险组感染情况相近;癌距肛门5~<7 cm患者行保护性造口比例从18.35%上升至39.86%,差异有统计学意义(χ^(2)=13.489,P<0.001),癌距肛门5~<7 cm患者术后器官腔隙感染率从16.51%降至4.20%。结论通过开展目标性监测、分级管理、推进保护性造口,直肠癌患者Dixon术后器官腔隙感染得到明显控制,中高风险组、癌距肛门距离5~<7 cm患者感染率明显降低。OBJECTIVE To estimate the effects of measures on prevention and control of postoperative organ space infection in patients undergoing transabdominal Dixon surgery.METHODS From 2017 to 2018,the patients with rectal cancer who underwent Dixon surgery in Peking University First Hospital and had postoperative organ space infection were assigned as the control group,the risk factors for the infection were investigated,the risk classification scoring system was established based on the result of analysis,the targeted monitoring was carried out for the patients who received surgical procedures from 2019 to 2021(the study group),precise concerns were given to the moderate-and high-risk patients,the effect of protective stoma was discussed with clinicians on basis of the condition of the patients.The incidence of infection and status of protective stoma were observed and compared between the control group and the study group.RESULTS There was no significant difference in the proportion of patients in moderate-and high-risk groups between the control group and the study group,the incidence of overall organ space infection was decreased from 7.83%to 3.08%,and there was significant difference(χ^(2)=12.116,P<0.001).In the study group,the overall infection rate of moderate-and high-risk group was decreased from 29.23%to 4.72%after the intervention measures were taken(P<0.001),which was similar to the low-risk group.The proportion of the patients with distance between cancer and anus ranging between 5 and 7 cm who underwent protective stoma was increased from 18.35%to 39.86%,and there was significant difference(χ^(2)=13.489,P<0.001);the incidence of postoperative organ space infection in the patients with distance between cancer and anus ranging between 5 and 7 cm was decreased from 16.51%to 4.20%.CONCLUSION The postoperative organ space infection has been effectively under control through targeted monitoring,classified management and protective stoma.The incidence of the infection is remarkably reduced among the patients of

关 键 词：风险分级 危险因素 直肠癌 器官腔隙感染 防控效果 

分 类 号：R735.37[医药卫生—肿瘤]