摘要
目的:分析胃十二指肠溃疡急性穿孔患者手术部位感染的相关因素,为临床提供参考。方法:回顾分析2012-07-01~2019-05-30胃十二指肠溃疡急性穿孔手术患者1178例的临床资料,对其发生手术部位感染的相关因素进行单因素与多因素Logistic回归分析,以确定胃十二指肠溃疡急性穿孔手术引起手术部位感染的相关因素。结果:1178例胃十二指肠溃疡急性穿孔手术患者中发生手术部位感染127例,感染率为10.78%。共检出121株病原菌,其中革兰阳性菌35株,占28.93%,革兰阴性菌82株,占67.77%,真菌4株,占3.31%。Logistic回归模型分析显示,随机血糖(≥11.1 mmol/L)、术式(胃大部切除)、引流时间(≥2 d)、腹膜炎表现(弥漫性)等是胃十二指肠溃疡急性穿孔手术部位感染的独立危险因素(P<0.05),胃肠减压、手术时机(穿孔后6 h)、冲洗液(含抗菌药物冲洗液)、术中预防使用抗菌药物、胃肠功能恢复时间(术后24 h)等是胃十二指肠溃疡急性穿孔手术部位感染的独立保护因素(P<0.05)。结论:胃十二指肠溃疡急性穿孔手术部位感染与多种因素有关,早期诊断急诊手术治疗,胃肠减压,减少腹腔感染扩散,合理选择手术方式,减少手术创伤,抗菌药物腹腔冲洗,保持腹腔引流管理通畅,及时评估早期拔除引流管,术中预防使用抗菌药物,有效控制血糖,促进胃肠功能早期恢复等综合措施,可有效减少胃十二指肠溃疡急性穿孔手术部位感染。
Objective:To analyze the related factors of surgical site infection in patients with acute perforation of gastroduodenal ulcer,and provide reference for clinical.Methods:Clinical data of 1178 patients with acute perforation of gastroduodenal ulcer from July 2012 to May 2019 were retrospective analyzed,and the factors related to surgical site infection were analyzed by univariate analysis and multivariate Logistic regression analysis,to determine the factors related to the infection of the surgical site caused by acute perforation of intestinal ulcer.Results:A total of 127 cases of surgical site infection occurred in 1178 patients with acute perforation of gastroduodenal ulcer,and the infection rate was 10.78%.A total of 121 strains of pathogenic bacteria were detected,including 35 strains of Gram-positive bacteria(28.93%),82 strains of Gram-negative bacteria(67.77%)and 4 strains of fungi(3.31%).Logistic regression analysis showed that blood glucose(≥11.1 mmol/L),surgery(mostly removed gastric),drainage time(≥2 d),peritonitis(diffuse),etc.were acute perforated surgical site infection of gastroduodenal ulcer independent risk factors(P<0.05),gastrointestinal decompression,timing of surgery(within 6 hours after perforation),flushing solution(including antibacterial rinsing solution),intraoperative prophylaxis with antibiotics,recovery time of gastrointestinal function(postoperative within 24 hours)were an independent protective factor for the infection of acute perforation of gastroduodenal ulcer(P<0.05).Conclusion:The surgical site infection of acute perforation of gastroduodenal ulcer is related to various factors.Early diagnosis and emergency surgery,gastrointestinal decompression,reducing the spread of abdominal infection,rational selection of surgical methods,reducing surgical trauma,antibacterial drug peritoneal washing,keep abdominal drainage management smooth,timely evaluation of early removal of drainage tube,prevention of antibiotics,effective control of blood glucose,and early recovery of gastrointesti
作者
谢朝云
蒙桂鸾
熊芸
杨忠玲
陈应强
杨怀
XIE Chaoyun;MENG Guiluan;XIONG Yun;YANG Zhongling;CHEN Yingqiang;YANG Huai(Department of Infection Management,the Third Affiliated Hospital of Guizhou Medical University,Duyun 558000,China;Department of Clinical Laboratory,the third Affiliated Hospital of Guizhou Medical University;Department of Infection,the Third Affiliated Hospital of Guizhou Medical University;Department of Infection Management,the People′s Hospital of Guizhou Province)
出处
《西北国防医学杂志》
CAS
2021年第1期36-42,共7页
Medical Journal of National Defending Forces in Northwest China
基金
贵州省科技厅联合资助项目[黔科合LH字(2014)7162号]
贵州省黔南州社会发展科技项目[黔南科合社字(2018)7号]。
