肝胆胰腺外科手术部位感染相关危险因素研究

摘要

目的：了解肝胆胰腺手术患者发生手术部位感染(SSI)的相关危险因素。方法选取2006年1月-2010年1月某三级甲等医院普通外科接受肝胆胰腺手术并发生 SSI的60例患者作为病例组，同时期普通外科接受肝胆胰腺手术但未发生 SSI的119例患者作为对照组，对其病历资料进行回顾性调查研究。结果单因素分析结果显示：年龄、心脑血管疾病史、腹部手术史、吸烟史、术前贫血、术前凝血功能和血糖异常、术前存在感染、是否使用腹腔镜、切口类型、手术持续时间、ASA评分、术后是否引流和术后24 h 内换药与肝胆胰腺手术患者发生 SSI相关(均P<0.05)。多因素分析结果显示：有腹部手术史[OR95%CI：3.09(1.21~7.91)]、NISS 评分高风险型[OR95%CI：6.18(2.41~15.85)]是肝胆胰腺手术患者发生 SSI 的危险因素，术后48 h 内换药[OR95%CI：3.81(1.56~9.34)]是其保护因素。结论腹部手术史及 NISS评分高是肝胆胰腺手术患者发生 SSI的主要危险因素，为降低患者 SSI风险，术前应积极调整患者血糖、纠正贫血和凝血功能异常；应尽量缩短手术持续时间，术后注意无菌操作，保持切口清洁、及时换药。%Objective To study the risk factors for surgical site infections (SSIs)in patients with hepatobiliary and pancreatic surgery.Methods Sixty patients who received hepatobiliary and pancreatic surgery and suffered SSIs from January 2006 to January 2010 were selected as infections group,119 patients who also received hepatobiliary and pancreatic surgery but didn’t develop infection were as control group,retrospective investigation was per-formed.Results Univariate analysis revealed the associated factors for post-operative SSIs were age,history of car-diocerebrovascular disease,history of abdominal surgery,history of smoking,preoperative anemia,abnormal pre-operative coagulation and blood sugar,pre-operative infection,use of laparoscope,incision type,duration of opera-tion,ASA score,post-operative drainage and dressing chang within 24 hours of post-operation(all P<0.05).Mult-ivariate analysis revealed that abdominal surgery history (OR95%CI:3.09 [1.21 -7.91 ]),high NISS score (OR95%CI:6.18[2.41-15.85])were risk factors of SSIs in patients with hepatobiliary and pancreatic surgery, and dressing chang within 48 hours of post-surgery were protective factor (OR95%CI:3.81 [1.56-9.34]). Conclusion History of abdominal surgery and high score of NISS are major risk factors for SSIs in patients with hepatobiliary and pancreatic surgery.To reduce the risk of SSIs,blood glucose should be actively adj usted,anemia and coagulation abnormalities should be treated;duration of operation should be shortened as far as possible,wound should be kept clean and dressing should be changed timely after surgery.