钟鸣 张志彬 李国花 黄丽群 齐灿文

[摘要] 目的 对I类手术患者术后切口感染的特征及影响因素进行分析，以此为制定防控措施提供依据。 方法 选择2018年1～12月我院某科室收治的171例I类手术切口患者临床资料进行分析，统计住院资料和感染相关因素等临床资料，对I类手术切口感染的影响因素进行归纳总结。 结果 在171例I类手術切口患者中，4例发生切口感染，I类手术切口感染的发生率为2.34%。对此4例患者的耐药性进行分析，发现青霉素、克林霉素、红霉素及阿莫西林等对患者的病情并无明显治疗作用。单因素分析结果显示，患者性别、年龄、基础疾病、营养状况、手术时长、住院时间、抗菌药物使用情况、切口置管情况、手术史、BMI及是否具有慢性疾病，对I类手术切口患者的术后切口感染均有一定影响，差异有统计学意义（P<0.05）。将单因素分析中差异有统计学意义的11个变量纳入多因素Logistic回归分析，结果显示基础疾病、住院时间、呼吸机使用时间、抗菌药物使用时间、尿管插管时间、中心静脉插管时间、手术史、BMI均为Ⅰ类手术切口患者术后医院感染的影响因素，差异有统计学意义（P<0.05）。上述因素中，患者是否具有基础疾病、抗菌药物应用时间、尿管插管时间3项因素对感染的影响同其他因素相比差异更加显著（P=0.000<0.01）。 结论 I类手术患者应采取积极措施控制其术后切口感染风险，对患者术后体征进行密切观察，合理使用抗菌药物，争取尽早拔除不必要的导管，最大程度地减少交叉感染风险，从而降低医院感染发生率。

[关键词] 乳房肿块;腹股沟疝;切口感染;影响因素;病原学

[中图分类号] R473.6;R472.1          [文献标识码] B          [文章编号] 1673-9701（2020）22-0151-05

Investigation on the etiological characteristics of type I incision infection and related factors of  infection control

ZHONG Ming   ZHANG Zhibin   LI Guohua   HUANG Liqun   QI Canwen

Department of Infection Management， Ganzhou Municipal Hospital in Jiangxi Province， Ganzhou   341000， China

[Abstract] Objective To analyze the characteristics and influencing factors of postoperative incision infections in the patients undergoing type I surgery， so as to provide a basis for the development of prevention and control measures. Methods The clinical data of 171 patients with type I surgical incision who were admitted to a department in our hospital from January to December 2018 were analyzed. The clinical data such as hospitalization data and infection-related factors were collected and statistically analyzed， and the influencing factors of type I surgical incision infection were summarized. Results Among the 171 patients with type I surgical incision， 4 cases had incision infection， and the incidence rate of type I surgical incision infection was 2.34%. Analysis of drug resistance in 4 patients revealed that penicillin， clindamycin， erythromycin and amoxicillin had no obvious therapeutic effect on the patient's condition. According to the results of single factor analysis， the patient's gender， age， underlying disease， nutritional status， duration of surgery， length of stay， use of antimicrobial drugs， incision tube placement， surgical history， BMI and complicated chronic diseases had a certain influence on postoperative incision infection in the patients with type I surgical incision， and the differences were statistically significant（P<0.05）. 11 variables with statistically significant differences in univariate analysis were included in the multivariate logistic regression analysis. The results showed that underlying diseases， length of stay， ventilator use time， antimicrobial use time， urinary catheterization time， central venous catheterization time， surgical history and BMI were all influencing factors for postoperative hospital infection in the patients with type I surgical incision， and the differences were statistically significant（P<0.05）. Among the above factors， the effects of underlying diseases， the time of antimicrobial use， and the time of urinary catheterization on infections had a more significant difference than other factors， and the differences were statistically significant（P=0.000<0.01）. Conclusion Patients with type I surgery should take active measures to control the risk of postoperative incision infection. Close observation on the patient's postoperative signs， rational use of antibacterial drugs， and early removal of unnecessary catheters can minimize the risk of cross-infection， thereby reducing the incidence of hospital infections.

[Key words] Breast lump; Inguinal hernia; Incision infection; Influencing factors; Etiology

I类手术属于清洁切口手术，术后患者出现伤口感染的概率很低，如果出现切口感染，会影响患者切口愈合以及术后恢复质量[1-3]。乳腺癌与腹股沟疝患者在临床上多数会接受外科手术治疗，完全切除病灶以达到延长患者生存率与提高患者生活质量的目的。但近几年的研究结果显示，乳腺癌与腹股沟疝手术极易出现各种并发症，其中切口医院感染最为常见，不仅对患者的术后康复有较为严重的影响，而且会增加患者及其家属的经济负担。……