剖宫产术后感染病原菌及影响因素  

Distribution of pathogens isolated from cesarean section puerpera with postoperative infection and influencing factors

作　　者：欧阳璇 黎玉辉[1] 宁昊 黄谦 OUYANG Xuan;LI Yu-hui;NING Hao;HUANG Qian(The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine,Guangzhou,Guangdong 510006,China;不详)

机构地区：[1]广州中医药大学第一附属医院麻醉科,广东广州510006 [2]益阳市妇幼保健院麻醉科,湖南益阳413000 [3]益阳市妇幼保健院产科,湖南益阳413000

出　　处：《中华医院感染学杂志》2024年第1期94-98,共5页Chinese Journal of Nosocomiology

基　　金：湖南省卫生健康委科研课题(202206035242)。

摘　　要：目的分析剖宫产术后产妇感染病原菌分布及其影响因素。方法回顾性收集2020年1月-2022年12月广州中医药大学第一附属医院及益阳市妇幼保健院收治的2048例剖宫产产妇临床资料,根据术后是否发生感染分为感染组102例和非感染组1946例,统计剖宫产产妇术后感染现状及感染部位、病原菌种类分布,多因素Logistic回归分析剖宫产产妇术后感染的影响因素,比较两组术前及术后72 h炎症、应激指标水平。结果剖宫产产妇术后感染率为4.98%,其中切口感染占比47.06%、泌尿系统感染占比24.51%、呼吸系统感染占比18.63%、生殖系统感染占比8.82%、腹腔感染占比9.80%;共分离出133株病原菌,主要感染病原菌种类为大肠埃希菌、铜绿假单胞菌、肠球菌、表皮葡萄球菌;体质量指数(BMI)、胎膜早破、羊水污染、合并妊娠期糖尿病、麻醉时间≥1h、术中出血量均为剖宫产产妇术后感染的独立危险因素(P<0.05),术前预防性使用抗生素为剖宫产产妇术后感染的保护因素(P<0.05);两组术后72 h血清白细胞介素(IL)-6、IL-10、去甲肾上腺素(NE)、皮质醇(COR)水平较术前均升高,且感染组高于非感染组(P<0.05)。结论剖宫产产妇术后感染率较高,感染部位包括切口、泌尿系统、呼吸系统、生殖系统、腹腔感染,主要感染病原菌种类为大肠埃希菌、铜绿假单胞菌、肠球菌、表皮葡萄球菌,其影响因素较多,产后感染的发生可引起产妇机体炎症、应激指标水平升高,影响其预后。OBJECTIVE To explore the distribution of pathogens and influencing factors for postoperative infection in the cesarean section puerpera.METHODS The clinical data were retrospectively collected from 2048 cesarean section puerpera who were treated in the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine and Yiyang Maternal and Child Health Hospital from Jan 2020 to Dec 2022.The enrolled puerpera were divided into the infection group with 102 cases and the non-infection group with 1946 cases according to the status of postoperative infection.The prevalence of postoperative infection,infection sites and species of pathogens were statistically analyzed.Multivariate logistic regression analysis was performed for the influencing factors for the postoperative infection.The levels of inflammatory factors and stress indexes were observed and compared be-tween the two groups before the surgery and after the surgery for 72 hours.RESULTS The incidence of postopera-tive infection was 4.98%among the cesarean section puerpera.The puerpera with incision infection accounted for 47.06%,the puerpera with urinary system infection 24.51%,the puerpera with respiratory system infection 18.63%,the puerpera with genital system infection 8.82%,the puerpera with abdominal infection 9.80%.To-tally 133 strains of pathogens were isolated;Escherichia coli,Pseudomonas aeruginosa,Enterococcus and Staph-ylococcus epidermidis were the major species of pathogens causing the infection.Body mass index(BMI),prema-ture rupture of membranes,amniotic fluid contamination,complication with gestational diabetes mellitus,anes-thesia duration no less than 1 hour and intraoperative blood loss volume were the independent risk factors for the postoperative infection in the cesarean section puerpera(P<0.05),preoperative prophylactic use of antibiotics was the protective factor for the postoperative infection(P<0.05).The levels of serum interleukin(IL)-6,IL-10,no-radrenaline(NE)and cortisol(COR)of the two groups were higher after the

关 键 词：产妇 麻醉 剖宫产 感染 炎症指标 应激指标 影响因素 

分 类 号：R619.3[医药卫生—外科学]