剖宫产术后切口感染的高危因素分析及预防性护理

目的探讨引起剖宫产切口感染的高危因素及预防性护理。方法采用回顾性调查法,由经过培训的调查员逐一查阅2002年1月-2007年6月全部剖宫产病案记录,按规定填写调查表,内容包括现病史、诊疗记录、病程记录、化验单、特殊检查、感染情况、抗生素使用情况及微生物学检验报告等,根据以上资料综合判断是否有剖宫产术后切口感染。根据相关文献选择切口感染的高危因素：体质量指数、血红蛋白水平、病房条件、季节、阴道检查次数、胎膜早破、预防应用抗生素、备皮至手术时间、手术时间。将80例剖宫产切口感染患者作为观察组,选择同期无切口感染剖宫产患者100例作为对照组,对可能影响切口感染的高危因素进行单因素分析与Logistic回归分析。结果影响切口感染的高危因素单因素分析发现产妇体质量指数高、血红蛋白水平低、住多人间病房、夏季、阴道检查次数多、胎膜早破、术前未预防应用抗生素、备皮至手术时间长、手术时间长等因素与剖宫产术后切口感染有关;Logistic回归分析确定手术时间长、夏季、胎膜早破、体质量指数高、未预防应用抗生素为切口感染的相关危险因素。结论应针对高危因素采取护理措施：缩短手术时间、完善夏季卫生管理、加强胎膜早破的护理、进行营养健康教育、预防应用抗生素,预防和控制切口感染。

The High Risk Factors of Postoperative Infection at Incision after Uterine-jncision Delivery and the Preventive Nursing

Objective To explore the high risk factors of postoperative infection at incision after uterine-incision delivery and the preventive nursing.Methods An trained researcher retrospectively reviewed the records of uterine-incision delivery undergone from Jan.2002 to Jun.2007,filling out the investigation forms concerning present history,diagnosis and management records,course records,reports for chemical analysis,special examination reports,infection records,use of antibiotics and reports for microbiological tests,based on which postoperative infections at incision after uterine-incision delivery were identified.The high risk factors were determined based on the reviewed literature as body constitution index,hemoglobin level,ward surroundings,season,times for vaginal examinations,premature rupture of membrane,preventive use of antibiotics,and span from surgical preparation to operation.80 cases with postoperative infection at incision after uterine-incision delivery were put in observation group and another 100 cases without infection at the same period in control group.The probable high risk factors were analyzed with single factor analysis and Logistic regression analysis.Results Single factor analysis showed such high risk factors as high body constitution index,low hemoglobin level,crowed ward surroundings,summer,frequent vaginal examinations,premature rupture of membrane,no preventive use of antibiotics,long time from surgical preparation to operation,and long time of operation were related to postoperative infections.Logistic regression analysis showed the high risk factors included high body constitution index,summer,premature rupture of membrane,no preventive use of antibiotics,and long time of operation.Conclusion Pertinent to the high risk factors,such nursing measures are used to prevent and management the incision infections as shortened time for operation,enhanced hygienic management at summer,intensified care to premature rupture of membrane,enhanced health education on nutrition,and using antibiotics