麻醉时间对剖宫产术后感染发生率及应激指标影响

目的:探讨麻醉时间对剖宫产术后感染发生率及应激指标的影响。方法:回顾性分析2016年1月30日—2019年4月30日本院剖宫产1200例临床资料,观察术后感染发生情况及术后感染特点、病原菌分布情况,并分析麻醉时间对术后感染影响及不同麻醉时间患者手术前后应激指标(去甲肾上腺素、皮质醇和血糖)变化。结果:术后感染70例(5.8%),切口感染为主(44.3%),其次为泌尿系统感染(22.9%),革兰阳性杆菌占55.6%,以金黄色葡萄球菌为主;革兰阳性杆菌占44.4%,以大肠埃希菌为主。术中出血≥200ml、术中输血、麻醉时间≥1h、术前未使用抗生素、侵入性检查≥5次及胎膜早破的产妇术后感染率增加(P<0.05)。多因素分析显示,术中出血≥200ml、麻醉时间≥1h、侵入性检查≥5次是剖宫产术后感染的危险因素,术前预防性使用抗生素是剖宫产术后感染保护因素(均P<0.05)。术后麻醉时间≥1h组去甲肾上腺素、皮质醇和血糖均高于麻醉时间<1h组(P<0.05)。结论:剖宫产术麻醉时间≥1h可增加术后应激水平及感染发生率,缩短麻醉时间及术前预防性使用抗菌药物是降低感染发生的有效措施。

Influence of length of anesthesia on the incidence of infection and stress indicators of women after cesarean section

Objective:To investigate the influence of length of anesthesia on the incidence of infection and stress indicators of women after cesarean section.Methods:The clinical data of 1,200 women who exprienced cesarean section from January 30,2016 to April 30,2019 were analyzed retrospectively.The incidence of postoperative infection,the characteristics of postoperative infection,and the distribution of pathogens of all included women were observed.The influence of anesthesia time on the incidence of infection,and the changes of levels of norepinephrine,cortisol and blood glucose of women were also analyzed.Results:There were 70(5.8%)women with postoperative infection,wich included 44.3%women with incision infections and 22.9%women with urinary system infections.The postoperative infection caused by gram-positive bacteria(mainly staphylococcus aureus)accounted for 55.6%,and the postoperative infection caused by gram-positive bacteria(mainly escherichia coli)accounted for 44.4%.The postoperative infection rate of women with maternal hemorrhage≥200ml,intraoperative blood transfusion,anesthesia time≥1h,no antibiotics used before operation,invasive examination≥5 times,or with premature rupture of membranes had increased significantly(P<0.05).Multivariate analysis showed that intraoperative bleeding≥200ml,anesthesia time≥1h,and invasive examination≥5 times were risk factors for postoperative infection,and prophylactic antibiotics used before cesarean section were protective factors(P<0.05).The levels of norepinephrine,cortisol and blood glucose of women with anesthesia time≥1h were significant higher than those of women with anesthesia time<1h(P<0.05).Conclusion:The anesthesia time during cesarean section over 1h can increase the stress level and infection incidence of women after cesarean section,so shortening anesthesia time and prophylactic antibiotics used before cesarean section can reduce the postoperative infection occurance effectivly.