剖宫产手术部位感染目标性监测效果分析
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孙红娟

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R181.3+2

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Efficacy of targeted monitoring on surgical site infection following caesarean section
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    摘要:

    目的了解剖宫产手术部位感染(SSI)发病情况,分析其危险因素,实施干预措施,评价干预后效果。方法监测2013年1—12月某院产科行剖宫产的所有产妇,调查分两个阶段进行:评估阶段(2013年1—6月);干预阶段(2013年7—12月)。采用目标性监测和临床干预相结合的方法,针对干预前发现的危险因素采取干预措施,比较干预前后SSI情况及住院时间、住院费用。结果共监测行剖宫产患者1 593例,发生SSI 31例,发病率1.95%。其中评估阶段SSI 发病率3.40%;干预阶段SSI发病率0.95%;干预前后SSI发病率比较,差异有统计学意义(χ2= 12.02,P<0.01)。评估阶段单因素分析表明,手术时间≥1 h、身体质量指数≥26 kg/m2、术中出血量≥300 mL、有基础疾病、有胎膜早破、未预防性使用抗菌药物是剖宫产患者SSI的危险因素(均P<0.05)。评估阶段648例患者手术后预防性使用抗菌药物时间以>48 h为主(395例,占60.96%);干预阶段945例患者手术后预防性使用抗菌药物时间以<24 h为主(776例,占82.12%);干预前后两阶段手术后预防性使用抗菌药物不同时间分布比较,差异有统计学意义(χ2=673.26,P<0.01)。31例SSI患者平均住院日为(13.83±3.26)d,非SSI患者为(7.06±1.66)d,差异有统计学意义(t=7.86,P<0.01);SSI患者平均住院费用为(9 044.77±2 649.19)元,非SSI患者为(6 254.73±638.52)元,差异有统计学意义(t=4.344,P<0.01)。结论针对剖宫产手术后SSI的危险因素采取干预措施,可有效降低剖宫产SSI发病率。

    Abstract:

    ObjectiveTo understand the occurrence of surgical site infection (SSI) following caesarean section, analyze risk factors, implement intervention measures, and evaluate intervention efficacy. MethodsAll puerperas who underwent caesarean section in the obstetric department of a hospital from January to December 2013 were monitored, investigation were performed in two stages: evaluation stage (JanuaryJune, 2013) and intervention stage (JulyDecember, 2013). Targeted intervention and clinical intervention were combined to intervene the risk factors. Occurrence of SSI, length of hospital stay, and hospitalization expense before and after intervention were compared. ResultsA total of 1 593 patients with caesarean section were monitored, 31(1.95%) had SSI, incidence of SSI in evaluation stage and intervention stage were 3.40% and 0.95% respectively;incidence of SSI before and after intervention was significantly different(χ2=12.02,P<0.01). Univariate analysis on evaluation stage showed that risk factors for SSI in patients with caesarean section were duration of operation ≥1 hour, body mass index ≥26 kg/m2, intraoperative blood loss ≥300 mL, underlying diseases, premature rupture of membranes, and without antimicrobial prophylaxis (all P<0.05). In evaluation stage, 648 patients received postoperative antimicrobial prophylaxis for>48 hours (n=395, 60.96%); in intervention stage, 945 patients received postoperative antimicrobial prophylaxis for<24 hours (n=776, 82.12%), different time distribution of postoperative antimicrobial prophylaxis in two stages after intervention was compared, difference was statistically significant(χ2=673.26,P<0.01). The mean length of hospital stay of 31 SSI patients were (13.83±3.26) days, nonSSI patients were (7.06±1.66) days, difference was statistically significant (t=7.86, P<0.01); the average hospitalization expenses for patients with SSI were (9 044.77±2 649.19) yuan, nonSSI patients were (6 254.73±638.52) yuan, difference was statistically significant (t=4.344, P<0.01). ConclusionIntervention measures for risk factors of SSI after caesarean section can effectively reduce the incidence of SSI in caesarean section.

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陈所仙, 吕庆排, 沈亚萍,等.剖宫产手术部位感染目标性监测效果分析[J]. 中国感染控制杂志,2018,17(4):359-362. DOI:10.3969/j. issn.1671-9638.2018.04.017.
CHEN Suoxian, LV Qingpai, SHEN Yaping, et al. Efficacy of targeted monitoring on surgical site infection following caesarean section[J]. Chin J Infect Control, 2018,17(4):359-362. DOI:10.3969/j. issn.1671-9638.2018.04.017.

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  • 收稿日期:2017-04-24
  • 最后修改日期:2017-06-12
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  • 在线发布日期: 2018-04-26
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