杨小云

摘 要 目的：探讨剖腹产后感染的相关因素及病原菌分布特点，为预防、治疗术后感染提供参考依据。方法：选取剖腹产术后感染的72例产妇作为研究对象，统计分析手术时间、住院时间、产程、是否伴有与感染相关的基础疾病、侵入性检查次数、胎膜早破、失血量及是否预防性应用抗菌药物等因素；采集切口分泌物进行细菌培养和鉴定。结果：logistic回归分析表明，当上述各因素达到一定阈值时均变成剖腹产术后感染的独立危险因素，差异均具有统计学意义（P<0.05）；72份切口分泌物中共培养出128株病原菌，以大肠埃希菌、肠球菌属、铜绿假单胞菌为主，分别占38.8%、17.4%和11.6%。结论：切口感染以革兰阴性菌、尤其大肠埃希菌为主，临床治疗时应合理使用抗菌药物，及时控制感染。

关键词 剖腹产术 感染因素 病原菌

中图分类号：R619.3 文献标识码：B 文章编号：1006-1533（2014）21-0055-03

The factors related to the cesarean infection

and the characteristics of pathogen distribution： a report with 72 cases*

YANG Xiaoyun

（Department of Gynecology and Obstetrics， Maternal and Child Health Hospital of Jiujiang City， Jiujiang 332000，China）

ABSTRACT Objective： To investigate the factors related to cesarean infection and the characteristics of pathogen distribution so as to provide a valuable reference for the prevention and treatment of postoperative infection. Methods： Seventy-two cases of parturients with postoperative infection were selected as subjects and the factors such as operation time， maternal hospitalization time， labor， underlying diseases associated with infection， the number of invasive examination， premature rupture of membranes， intraoperative blood loss and prophylactic use of antimicrobial drugs were statistically analyzed and incision secretions were collected and cultivated for the identification of bacteria. Results： Logistic regression analysis showed that the factors above-mentioned all became independent risk factors for postoperative infection when reached a certain threshold. The differences were statistically significant （P<0.05）. One hundred and twenty pathogenic bacteria were found from the cultures of 72 incision secretions， in which Escherichia coli， Enterococcus and Pseudomonas aeruginosa accounted for 38.8%， 17.4% and 11.6%， respectively. Conclusion： The majority of microbial infection is Gram negative bacteria， especially Escherichia coli， which should be controlled by rational use of antimicrobial agents.

KEY WORDS cesarean section； infection factors； pathogenic bacteria；

随着晚育、只生一胎比例增高等因素的影响，胎儿过大、胎膜早破、胎位不正、胎儿窘迫、产程迟滞等异常妊娠和多胞胎增多，采取剖腹产术分娩婴儿的机率增高。剖腹产术是指切开产妇的腹部及子宫，取出婴儿，可以解决产妇难产和某些产科并发症，从而减少产妇和围产儿的死亡率[1]，是产科领域中的重要手术。但由于剖腹产术产生切口，易引起术后感染，而且由于存在很多抗菌药物滥用情况，导致人体内菌群失调，耐药菌增多[2]，从而导致术后感染的治疗存在一定的困难。探讨剖腹产后感染的相关因素及病原菌分布特点，可为有效预防、治疗术后感染提供参考依据。

资料与方法

一般资料

选取2009年1月-2014年3月行剖腹产术并且在术后发生感染的72例产妇作为研究对象，年龄22～37岁，平均（27.16±3.41）岁，孕周36.9～40.5周，平均（37.23±1.38）周，住院时间5～14 d，平均（8.59±2.88）d。……