成人心脏直视术后手术部位感染危险因素分析

目的 探讨成人心脏直视术后手术部位感染(SSI)发生的危险因素,为控制SSI的发生提供依据.方法 对本院心脏外科2001年1月至2009年12月间体外循环心脏直视术后发生SSI 54例成年患者临床资料进行分析,按1:3比例配对选取对照组.对2组患者的临床资料中SSI的潜在危险因素进行单因素和多因素条件Logistic回归分析.结果 单因素条件Logistic分析:左心室射血分数(LVEF)<50%(OR=2.134,95%CI:1.095～4.159,P=0.026),心功能NYHA≥Ⅲ级(OR=2.390,95%CI:1.218～4.690,P=0.011),糖尿病(OR=3.275,95%CI:1.391-7.708,P=0.007),慢性阻塞性肺疾病(COPD)(OR=5.408,95%CI:1.248～23.445,P=0.024),体外循环时间>90 min(OR=3.045,95%CI:1.540～6.024,P=0.001),手术时间>4 h(OR=3.281,95%CI:1.610～6.685,P=0.0131),血液制品用量>2 U(OR=1.929,95%CI:1.018～3.675,P=0.044),切口连续缝合(OR=2.344,95%CI:1.221～4.498,P=0.010),二次开胸止血(OR=6.625,95%CI:1.597～27.491,P=0.009),术后高血糖(OR=3.510,95%CI:1.596～7.718,P=0.002),重症监护病房入住>72 h(OR=3.281,95%CI:1.505～7.150,P=0.003)与SSI发生相关.多因素条件Lgistic回归分析显示:手术时间>4 h(OR=3.100,95%CI:1.470～6.537,P=0.003)、切口皮下层连续缝合(OR=2.340,95%CI:1.183～4.692,P=0.015)、术后高血糖(OR=3.272,95%CI:1.427～7.505,P=0.005)是SSI的独立危险因素.结论 手术时间>4 h、切口皮下连续缝合及术后高血糖是心脏直视术后SSI发生的危险因素.

A case-control study on risk factors analysis of surgical site infection in adult patients after major heart surgery

Objective To investigate the risk factors of surgical site infection ( SSI) in adult patients undergoing major heart surgery, and to provide the reference of controlling the development of SSI. Methods A case-control study was conducted with 54 SSI patients underwent major heart surgery from January 2001 to December 2009 in the case group and 162 controls in the control group. Univariate and multivariate conditional logistic regression analysis were used to analyse the risk factors of SSI development Results Univariate conditional logistic regression showed the risk factors for the development of SSI were left ventricular ejection fraction ( LVEF) < 50% (odds ratio ( OR) = 2.134,95% C/: 1.095 - 4. 159, P = 0. 026) , heart function New York Heart Association classification (NYHA) ≥Ⅲ grade, (OR =2. 390,95% CI: 1. 218 -4. 690; P = 0. 011) .diabetes (OR=3.275, 95% CI: 1.391 - 7. 708; P = 0.007), chronic obstructive pulmonary disease (COPD) ( OR = 5. 408,95% CI: 1.248- 23.445,P = 0.024),extracorporeal circulation time>90 mins ( OR =3. 045,95% CI: 1.540 - 6.024, P = 0. 001 ) , operation time > 4 h ( OR = 3. 281, 95% CI: 1. 610 - 6. 685, P = 0.001 ) , blood product consumption >2 u ( OR = 1. 929,95% CI; 1. 018 -3. 675;P =0. 044) .incision continuous suture close ( OR = 2.344,95%CI: 1.221 -4.498;P =0.010) exploration for bleeding (OR =6. 625,95%CI: 1.597-27.491 ;P =0. 009) , postoperative hyperglycemia (OR = 3. 510,95%CI:l. 5% -7. 718;P =0. 002) ,the stay in intensive care units (ICU) > 72 h ( OR = 3. 281,95% CI: 1. 505 - 7. 150;P = 0. 003). Multivariate analysis showed 3 variables increased with the risk of SSI: operation time >4h (OR = 3. 100,95% CI: 1.470 - 6. 537,P = 0.003 ) , incision continuous suture close (OR =2. 340,95% CI: 1. 183 - 4. 692, P = 0. 015 ) , and postoperative hyperglycemia (OR = 3. 272,95% CI:1.427 -7. 505,P=0. 005 ). Conclusions This study shows that the operation time >4 h, incision continuous suture close and postoperative hyperglycemia are risk factors most likely associated with SSI development in major heart surgery.