摘要
目的探讨肝胆手术患者术后切口感染的原因并提出相应的预防措施,以降低手术患者切口感染的风险。方法回顾性调查2003年2月-2012年2月医院收治的708例肝胆患者临床资料,对发生切口感染的原因进行分析,并提出相应的预防措施。结果 708例肝胆手术患者发生切口感染57例,发生率为8.05%;糖尿病患者感染率为20.48%,总胆红素≥171μmol/L、白细胞≥10×109/L、血红蛋白含量≤10g/L者感染率分别为10.88%、12.07%、10.94%,术前住院时间>3d、手术时间>3h、采取开腹手术、未使用聚维酮碘冲洗切口、术中应用血制品、术后引流发生切口感染率分别为11.19%、28.85%、13.35%、29.76%、19.90%、13.67%,符合上述条件的患者术后切口感染率明显较高(P<0.05);手术时间<2h和未发生术后并发症的患者切口感染率分别为2.05%和4.25%,明显低于手术时间≥2h以及发生术后并发症的患者,差异有统计学意义(P<0.05);而切口方向为圆孔、长度<10cm、术后引流时间<5d的患者均未发生切口感染,切口感染率亦明显较低(P<0.05);多因素logistic回归分析显示,手术时间、手术切口分类、术中出血量、切口是否使用聚维酮碘进行冲洗以及有无并发症与肝胆手术患者术后切口感染的发生有着显著的关系。结论肝胆术后切口感染与患者自身及手术等多方面因素相关,针对这些原因采取有效的预防措施,根据患者的不同情况有侧重的进行切口管理,增强医护人员的责任心,可以有效降低切口感染率,有利于改善患者预后。
OBJECTIVE To investigate the causes and preventive measures for postoperative wound infections in the patients undergoing the hepatobiliary surgery so as to prevent the incision infections. METHODS The clinical data of 708 patients who underwent the hepatobiliary surgery from Feb 2003 to Feb 2012 were retrospectively investigated,and the causes for the incision infections were analyzed, the appropriate preventive measures were proposed. RESULTS Of 708 patients undergoing the hepatobiliary surgery, the incision infections occurred in 57 cases wish the incidence rate of 8.05%. The infection rate of the diabetic patients was 20.48%. The infection rates of the patients with the total bilirubin ≥171μmol/L, white blood cell count ≥10 × 109/L, and hemoglobin content ≤ 10 g/L were 10. 88%, 12. 07%, and 10. 94%, respectively. The incidence rates of the incision infections in the patients with the preoperative length of stay more than 3 days, operation duration more than 3 hours, laparotomy, without using povidone-iodine to rinse the incision, intraoperative use of blood products, and postoperative drainage were 11. 19%, 28.85%, 13.35%, 29. 76%, 19.90% and 13.67%, respectively. The postoperative wound infection rates that were in line with the above conditions were significantly higher （P〈 0.05）. The infection rates of the patients with the operation duration less than 2 hours and the patients without postoperative complications were 2. 05% and 4. 25%, significantly lower than those of the patients with the operation duration more than 2 hours and the patients with postoperative complications the uifference was statisticacy signifiunt （P〈0. 05）. There were no incision infections that occurred in the patients with circular incision, more than 10 cm of the length, and the duration of postoperative drainage less than 5 days, and the incision infection rate was comparatively low （P〈0.05）. The multivariate logistic regression analysis showed that the operation duration,surgical incision classification, blood loss, use of povidone-iodine to rinse the incision,and the complication were closely related to the incidence of the postoperative incision infections. CONCLUSION The incidence of incision infections is related to the patients themselves and the hepatobiliary surgery,according to the causes and the various conditions of the patients, the effective prevention measures should be taken and the incision management should be attached great importance so as to effectively reduce the incidence of incision infections and improve the prognosis of the patients.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2013年第2期326-328,共3页
Chinese Journal of Nosocomiology
关键词
肝胆手术
切口感染
原因
预防
Hepatobiliary surgery
Wound infection
Cause
Prevention
