普外科Ⅰ类手术术后切口感染危险因素logistic回归分析被引量：21

Logistic regression analysis of risk factors for postoperative incision infections in patients undergoing type Ⅰ general surgery

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摘要目的分析普外科Ⅰ类手术术后切口感染的相关危险因素,为临床预防感染提供参考。方法选取2011年1月-2017年2月医院普外科行无菌手术患者11125例,对手术术后切口感染的相关危险因素进行单因素与多因素回归分析,以确定引起普外科Ⅰ类手术术后切口感染的危险因素。结果 11125例普外科Ⅰ类手术术后发生切口感染97例,感染率为0.87%;单因素分析显示,恶性肿瘤、糖尿病史、BMI值(≥25kg/m^2)、手术方式(开放)、切口大小(≥10cm)、手术时间(≥1h)、出血量(≥500ml)、切口引流、切口渗血、血红蛋白浓度(<90g/L)、血清白蛋白浓度(<30g/L)、血糖(≥10mmol/L)均是普外科Ⅰ类手术术后切口感染的相关危险因素(P<0.05),其中血糖(≥10mmol/L)、手术方式(开放)、手术时间(≥1h)、切口引流、切口渗血、血清白蛋白浓度(<30g/L)、血红蛋白浓度(<90g/L)、BMI值(≥25kg/m^2)等是普外科Ⅰ类手术术后切口感染的独立危险因素(P<0.05)。结论普外科Ⅰ类手术术后切口感染与多个危险因素有关,临床首先应做好术前准备,控制血糖、纠正低蛋白血症与贫血;其次尽量采用微创治疗手段,缩短手术时间;再次是术中彻底止血,减少不必要的引流,关注肥胖患者切口情况等为主的综合措施,是有效降低普外科Ⅰ类手术术后切口感染的方法。 OBJECTIVE To investigate the related risk factors for postoperative incision infections in patients undergoing typeⅠ general surgery so as to provide guidance for clinical prevention of the infections.METHODS A total of 11125 patients who received aseptic surgery in the department of general surgery from Jan 2011 to Feb 2017 were enrolled in the study.The univariate analysis and multivariate regression analysis were performed for the related risk factors for the postoperative incision infections so as to determine the risk factors for the postoperative incision infection in the patients undergoing the typeⅠ general surgery.RESULTS Of the 11125 patients who received the typeⅠ general surgery,97 had the postoperative incision infections,with the infection rate 0.87% .The univariate analysis indicated that the related risk factors for the postoperative incision infections in the patients undergoing the typeⅠ general surgery included malignant tumor,history of diabetes mellitus,BMI no less than 25 kg/m-2,open surgery,length of incision no less than 10 cm,operation duration no less than 1 hour,bleeding volume no less than 500 ml,incision drainage,incision bleeding,hemoglobin concentration less than 90 g/L,serum albumin concentration less than 30 g/L and blood glucose no less than 10 mmol/L（P〈0.05）.The independent risk factors for the postoperative incision infection in the patients undergoing the typeⅠ general surgery included the blood glucose no less than 10 mmol/L,open surgery,operation duration no less than 1 hour,incision drainage,incision bleeding,serum albumin concentration less than 30 g/L,hemoglobin concentration less than 90 g/L and BMI no less than 25 kg/m-2（P〈0.05）.CONCLUSIONThere are a variety of risk factors for the postoperative incision infections in the patients undergoing the typeⅠ general surgery.It is necessary for the hospital to firstly take good preoperative preparation,control the blood glucose and correct hypoproteinemia and anemia,secondly try to adopt minimally invasive treatment means and shorten the operation duration,thirdly stop the bleeding thoroughly during the surgery,reduce the unnecessary drainage and focus on the incision status of obesity patients so as to effectively reduce the incidence of the postoperative incision infections in the patients undergoing the typeⅠgeneral surgery.