麦燕玲

【摘要】 目的：研究圍术期不同皮肤准备工作对子宫肌瘤剔除术患者皮肤清洁度、预后感染情况的影响，并分析切口感染病原学。方法：筛选2016年8月-2017年9月本院妇科收治的子宫肌瘤患者100例，所有患者均接受子宫肌瘤剔除术治疗，将研究对象根据随机数字表法分为观察组和对照组，各50例。对照组采用温水沐浴，在温水沐浴后观察组使用自制中药专方进行全身擦浴，擦浴由专业责任护士完成；其他皮肤准备工作两组均相同。手术开始皮肤常规消毒铺巾前于术区皮肤采样，并做细菌培养；对比两组经不同皮肤准备后切口感染发生率、菌落数量、种类。结果：观察组患者皮肤菌落数、菌落种类均明显低于对照组（P<0.05）；观察组菌落阳性检出率明显低于对照组（P<0.05）；观察组术后切口感染发生率明显低于对照组（P<0.05）。100例患者中检出26例患者发生病原菌感染，共检出病原菌169个菌株，其中以革兰阳性菌的金黄色葡萄球菌（19.53%）、革兰阴性菌的大肠埃希菌（28.99%）感染为主。经析因设计分析显示，剃毛与否并不影响术后切口感染；而皮肤清洁方法、备皮时间是影响切口感染的重要因素（P<0.05），且皮肤清洁方法是影响术后切口感染的独立危险因素（P<0.01）。结论：子宫肌瘤剔除术围术期皮肤准备工作是预防术后切口感染的关键，术前皮肤准备工作在控制备皮时间等变量前提下，对术区皮肤使用温水沐浴联合中药专方全身擦浴，可有效提高妇科择期手术皮肤清洁度、减少皮肤细菌种类、预防切口感染发生，提高患者手术安全性。

【关键词】 皮肤准备； 子宫肌瘤剔除术； 中药擦浴； 切口感染

Effect of Perioperative Skin Preparation on Skin Cleanliness and Prognosis of Patients with Myomectomy and Etiological Analysis of Incisional Infection/MAI Yanling.//Medical Innovation of China，2018，15（17）：087-091

【Abstract】 Objective：To study the skin cleanliness， prognosis and etiological analysis of incisional wound infection in patients with myomectomy under different skin preparation during perioperative period，and to analyze the etiology of incision infection.Method：A total of 100 patients with uterine leiomyoma treated by gynecology in our hospital from August 2016 to September 2017 were selected，all patients underwent myomectomy.The subjects were divided into observation group and control group，according to random number table method，50 cases in each group.The control group was treated with warm water bath，after warm bathing，the observation group used self-made proprietary Chinese medicines to wipe the whole body，the sponge bath was completed by a professional responsible nurse.Other skin preparations were the same for both groups.Before operation，the skin was routinely disinfected and samples were taken from the skin of the operation area and bacterial culture was performed.The incidence of incision infection，the number and kind of colonies after skin preparation were compared between the two groups.Result：The number of skin colonies and the species of colonies in the observation group were significantly lower than those in the control group（P<0.05）；the positive rate of colony in the observation group was significantly lower than that in the control group（P<0.05）；the incidence of postoperative incision infection in the observation group was significantly lower than that in the control group（P<0.05）.Of the 100 patients，26 cases were found to have pathogenic bacteria infection， and 169 strains were detected，among them，staphylococcus aureus （19.53%） and gram-negative escherichia coli（28.99%） were the main pathogens of gram-positive bacteria.Factorial design analysis showed that shaving or not does not affect postoperative wound infection，skin cleaning method and skin preparation time were important factor affecting incision infection（P<0.05），skin cleaning was an independent risk factor for postoperative wound infection（P<0.01）.Conclusion：Perioperative skin preparation for uterine myomectomy is the key to prevent incision infection. Preoperative skin preparation work under the premise of controlling the time of skin preparation and other variables，which can effectively improve the skin cleanliness of gynecological elective surgery，reduce the types of skin bacteria，prevent incision infection and improve the safety of patients.

【Key words】 Skin preparation； Myomectomy； Chinese medicine sponge bath； Incision infection

First-authors address：Foshan Gaoming District Peoples Hospital，Foshan 528500，China

doi：10.3969/j.issn.1674-4985.2018.17.023

切口感染是临床手术后的常见症状，一旦发生不仅增加临床治疗、护理难度，同时增加患者痛苦、经济负担，甚至影响疗效，诱发医患纠纷；为控制医院感染发生，术前备皮至关重要[1]。皮肤准备工作是围术期术前必备环节，其目的是杀灭术区皮肤暂居的致病菌、减少细菌数量、提高皮肤清洁度，同时尽量保证皮肤的完整性，预防术后感染。临床中于20世纪20年代将术区皮肤清洁与毛发剃除列为临床护理常规，被广泛应用于临床，并一直沿用[2-3]。随着临床深入研究，董淑芳等[4]对术前剃毛护理产生质疑，并指出术前剃毛与否并不影响切口感染发生。术后切口感染影响因素较为复杂，术区皮肤清洁方法较多，且不同方法效果差异较大；……