胃肠外科腹腔镜切口感染病原菌及感染原因分析#br#

［摘要］ 目的 分析胃肠外科腹腔镜手术切口感染的病原菌及危险因素，以制定针对性强的感染控制对策。 方法 统计胃肠外科腹腔镜手术患者切口感染情况，并进行统计学分析。 结果 867例患者中发生切口感染21例，感染率2.42%。阑尾切除手术感染率最高。病原菌分析：革兰阳性菌7株（33.33%），革兰阴性菌13株（61.90%），真菌1株（4.76%)。患者年龄＞60岁、体重指数＞25、罹患糖尿病、手术时间＞90 min、切口处标本通过、未使用抗菌药物、麻醉评分Ⅲ～Ⅳ级、有腹腔感染、未进行切口保护、手术部位在下消化道及住院时间＞8 d者感染发生率较高，进一步行Logistic回归分析，结果显示年龄＞60岁、体重指数＞25、罹患糖尿病是腹腔镜手术切口感染的危险因素（P＜0.05）。 结论 对高龄、肥胖和罹患糖尿病患者行腹腔镜手术时应特别注意切口感染的预防。

Analysis of pathogenic bacteria and causes of laparoscopic incision infection in gastrointestinal surgery

［Abstract］Objective To make targeted infection control strategies by analyzing pathogenic bacteria and risk factors of laparoscopic incision infection in gastrointestinal surgery. Methods The infection of incision in laparoscopic operation of gastrointestinal surgery was statistically analyzed. Results A total of 21 cases of 867 patients developed wound infection, the infection rate was 2.42%. The highest infection rate was appendectomy. Pathogen analysis: 7 strains of gram-positive bacteria(33.33%), 13 strains of gram-negative bacteria(61.90%), and 1 strain of fungus(4.76%). Patients with age >60 years old, body mass index（BMI）>25, diabetes mellitus, operation time>90 minutes, sample passing at incision, no use of antibiotics, anesthesia score of grade Ⅲ-Ⅳ, abdominal infection, no incision protection, lower digestive tract at operation site and hospitalization time >8 days had higher incidence of infection. Logistic regression analysis showed that age＞60 years, BMI＞25, and those with diabetes were risk factors for laparoscopic incision infection （P＜0.05）. Conclusion Special attention should be paid to the prevention of incision infection in laparoscopic surgery for the elderly, obese and diabetic patients.