摘要
目的探讨肝切除术后发生切口感染的危险因素。方法回顾性分析2015年5月至2018年5月上海市第六人民医院收治的427例行肝切除术患者的临床资料,统计患者术后切口感染情况,对感染切口分泌物进行病原学分析,并探讨肝切除术后发生切口感染的危险因素。结果 427例肝切除术患者中,发生术后切口感染24例,感染发生率为5.62%;24例切口感染患者共检出39株病原菌,革兰氏阴性菌占58.97%(23/39)。多因素Logistic回归分析结果显示,年龄≥60岁,体质指数≥25 kg/m^2、有糖尿病病史、手术时间≥3 h、Ⅲ类切口、术中出血量≥800 ml、引流管放置时间≥7 d均为患者肝切除术后切口感染的独立危险因素(均P<0.05),使用碘伏冲洗伤口、术后48 h换药均是患者肝切除术后切口感染的保护因素(均P<0.05)。结论肝切除术后切口感染的主要病原菌为革兰氏阴性菌,临床治疗和护理过程中应重点防范革兰氏阴性菌感染,并对存在高危因素的患者实施针对性的干预措施,进而降低肝切除术后切口感染发生率。
Objective To explore the risk factors of incision infection after hepatectomy.Method The clinical data of 427 patients underwent hepatectomy admitted to Shanghai Sixth People's Hospital from May 2015 to May 2018 were retrospectively analyzed.The incision infection condition was statistically analyzed.Infectious etiology analysis was performed on incision secretions of infected patients.The risk factors of incision infection after hepatectomy were analyzed.Result Of the 427 patients who underwent hepatectomy,there were 24(5.62%)cases with postoperative incision infection.Among 24 cases with incision infection,there were 39 strains of pathogens,including 23(58.97%)strains of Gram-negative bacteria.Multivariate Logistic regression analysis showed that age≥60 years old,body mass index≥25 kg/m^2,diabetes mellitus history,operation time≥3 h,typeⅢincision,intraoperative blood loss≥800 ml,drainage tube placement time≥7 days were independent risk factors of incision infection in patients after hepatectomy(all P<0.05),while wound irrigation with iodophor and dressing change within 48 h after surgery were protective factors of incision infection in patients after hepatectomy(all P<0.05).Conclusion After hepatectomy,main pathogen of incision infection is Gram-negative bacteria.Clinical treatment and nursing should focus on preventing Gram-negative bacterial contamination,and carry out targeted intervention measures for patients with high risk factors,so as to reduce the incidence of incision infection after hepatectomy.
作者
姜秋艳
薛梅
Jiang Qiuyan;Xue Mei(Department of Tumor Radiotherapy,Shanghai Sixth People's Hospital,Shanghai 200233,China)
出处
《中国医学前沿杂志（电子版）》
2020年第6期121-124,共4页
Chinese Journal of the Frontiers of Medical Science(Electronic Version)
基金
上海市第六人民医院院级科学研究基金(院内-2053)。
