心脏直视术后手术部位感染相关风险因素的回顾分析

发布时间：2018-05-12 03:09

  本文选题：SSI + 危险因素　； 参考：《新乡医学院》2015年硕士论文

【摘要】：背景：手术部位感染(Surgical site infection, SSI)是一种普遍的卫生保健相关的感染,在美国的整体手术并发症中占2-5%。在我国部分地区胸部手术术后手术部位感染的发病率为5.87%。而更大范围的研究表明心脏术后手术部位感染的发生率为0.6%-6.6%,但是梁伟涛等的调查分析胸骨正中切口感染率则是1.4%,尤颢等[5]的研究结果为心脏直视手术术后手术部位感染发病率2.87%,不同于其他报道。SSI相关的发病率和死亡率均增加,从表面伤口感染相关的切口液化到有生命危险的重症脓毒症,并且发生手术部位感染的风险因素是复杂多样的。在基于临床实践的观察研究中可以发现多种风险因素和其他影响因素,对于更大范围的临床研究来说,对SSI发生的研究并不只局限于特定的某一风险因素。手术部位感染作为医疗保健系统的一个持续性挑战和负担,需要我们对其发生机制和促进因素有更准确和特异性的判断,并且要对当前预防措施的效能有精确评估。目的：通过对心脏外科直视术后手术部位感染发生的相关风险因素,可能的具体机制,现行的预防和处理措施进行更准确和全面的评估,为临床实践中对SSI的认识、预防和治疗提供精确可靠的科学基础,并探索建立心脏外科病人术后手术部位感染的预测模型的可行性。方法：回顾性分析某三甲医院心血管外科2011年1月至2014年10月进行直视下心脏手术1384例,其中术后手术部位感染患者51例,与同期未发生手术部位感染的患者按1：2配比法进行相关风险因素分析,涉及的风险因素包括性别、年龄、体重指数、吸烟、糖尿病、手术时间等,数据使用SSPS 22.0软件分析。结果：全部1384例心脏直视手术后手术部位感染患者51例,感染率为3.68%,其中切口浅表部位、深部及纵膈内感染的比例分别为84.31%(43例)、13.73%(7例)及1.96%(1例)。多因素条件logistic回归分析认为,手术时间(2.5小时)、术后ICU时间(2天)、术后发热(3天,38.5℃)是SSI的独立相关因素(P0.05)。结论：心脏直视术后手术部位感染发生率较高,其发生与以下因素有关：糖尿病、手术时间、术后ICU时间、术后发热等。除常规预防措施外,减少手术时间,改进术后病人ICU治疗与护理可减少SSI发生几率,病人术后ICU停留时间增加和术后发热可成为手术部位感染的预测或诊断指标。可根据心脏外科手术的特点建立手术部位感染的预测模型。
[Abstract]:Background: Surgical site infection, SSI), a surgical site infection, is a common health care related infection, accounting for 2-5% of the overall surgical complications in the United States. The incidence of postoperative site infection in some parts of China is 5.87. A larger study showed that the incidence of postoperative infection was 0.6-6.6, but the infection rate of median sternum incision was 1.4 and you Hao et al. [5] was the operative part of open heart surgery. The incidence of site infection was 2.87, which was different from other reports. SSI-related morbidity and mortality increased, From wound liquefaction associated with superficial wound infection to life-threatening severe sepsis, the risk factors for surgical site infection are complex and varied. A variety of risk factors and other influencing factors can be found in observational studies based on clinical practice. For a wider range of clinical studies, the research on the occurrence of SSI is not limited to a particular risk factor. As a persistent challenge and burden of the health care system, surgical site infection requires us to have a more accurate and specific judgment on its pathogenesis and promotion factors, and to accurately evaluate the effectiveness of current preventive measures. Objective: to evaluate more accurately and comprehensively the risk factors, possible mechanism, prevention and treatment of postoperative infection in open heart surgery, so as to make a better understanding of SSI in clinical practice. To provide accurate and reliable scientific basis for prevention and treatment, and to explore the feasibility of predicting surgical site infection in cardiac surgery patients. Methods: from January 2011 to October 2014, 1384 patients who underwent open vision heart surgery in cardiovascular surgery in a third Class A Hospital were retrospectively analyzed, including 51 patients with postoperative site infection. The data were analyzed by SSPS 22.0 software, including sex, age, body mass index, smoking, diabetes, operation time and so on. Results: there were 51 cases (3.68%) of all 1384 patients with infection after open heart surgery. The infection rates in superficial, deep and mediastinal areas of incision were 84.31 and 13.737.37, respectively. Multivariate conditional logistic regression analysis showed that the operation time was 2.5 hours, the postoperative ICU time was 2 days, and the postoperative fever was 38.5 鈩，

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