摘要
背景腹腔镜下手术治疗已经是胃癌根治术的首选方法,医院感染是术后常见并发症之一,严重影响患者术后恢复.目前国内关于腹腔镜手术感染的研究报道较多,但是对整体医院感染的临床特点研究较少.本研究对在我院行腹腔镜下胃癌根治术患者发生医院感染的病原菌分布及危险因素进行分析,以为临床诊疗和护理提供客观依据.目的腹腔镜下胃癌根治术患者术后发生医院感染的病原菌分布及危险因素分析.方法选择2016-10/2019-10在浙江省义乌市中心医院住院治疗胃癌根治术患者175例为研究对象,均于腹腔镜下手术治疗.认真详细记录所有患者一般资料,如性别,年龄,病理类型,胃癌分期,术前住院时间,腹腔镜治疗时间,有创性操作,糖尿病史,吸烟史,饮酒史等指标以及是否发生医院感染.结果175例胃癌患者术后有20例(占11.43%)发生医院感染.其中肺部感染11例(占6.29%),其次是腹腔感染6例(占3.43%),再者是切口感染和尿路感染,分别2例(占1.14%)和1例(占0.57%).发生医院感染的20例患者共分离培养出24株病原菌,其中革兰阴性菌较多,共15株(占62.5%),革兰阳性菌9株(占37.5%).单因素分析表明,年龄,胃癌分期,手术时间,糖尿病史,吸烟史等因素是术后发生医院感染的影响因素,差异有统计学意义(P<0.05,或P<0.01);而性别,病理类型,术前住院时间,术中出血量,饮酒史等因素比较,差异无统计学意义.通过多元回归分析发现,年龄≥70岁,胃癌分期≥Ⅲ期,手术时间≥3 h,有糖尿病史及吸烟史是术后发生医院感染的独立危险因素(P<0.01).结论年龄、胃癌分期、手术时间、糖尿病史及吸烟史是腹腔镜下胃癌根治术患者术后发生医院感染的独立风险因素,在工作中对于具有上述危险因素时,要积极采取措施预防发生医院感染.
BACKGROUND Laparoscopic surgery has been the preferred method of radical gastrectomy for gastric cancer,and nosocomial infection is one of the common postoperative complications,which seriously affects the postoperative recovery of patients.At present,there are many reports on infection in laparoscopic surgery in China,but few studies focus on the clinical characteristics of overall nosocomial infection.In this study,we analyzed the distribution of pathogenic bacteria and risk factors of nosocomial infection in patients undergoing laparoscopic radical gastrectomy at our hospital to provide an objective basis for clinical diagnosis,treatment,and nursing.AIM To investigate the distribution of pathogenic bacteria and risk factors of nosocomial infection after laparoscopic radical gastrectomy in a tertiary hospital.METHODS A total of 175 patients admitted to Yiwu Central Hospital of Zhejiang Province for radical gastrectomy of gastric cancer from October 2016 to October 2019 were selected as the study subjects,all of whom underwent laparoscopic surgery.General information of all patients,such as gender,age,pathological type,gastric cancer stage,preoperative hospital stay,time of laparoscopic treatment,invasive operation,history of diabetes,smoking,alcohol consumption,and other indicators,as well as the occurrence of nosocomial infection,was carefully recorded.RESULTS Among the 175 patients with gastric cancer,20(11.43%)developed nosocomial infection.There were 11 cases of pulmonary infection(6.29%),6 cases of abdominal infection(3.43%),2 cases of incision infection(1.14%),and 1 case of urinary tract infection(0.57%).A total of 24 strains of pathogenic bacteria were isolated and cultured from 20 patients with nosocomial infection,among which 15(62.5%)were Gram-negative and 9(37.5%)were Gram-positive.Univariate analysis showed that age,tumor stage,operation time,diabetes history,and smoking history were factors significantly influencing postoperative nosocomial infection(P<0.05 or P<0.01).There was no significant difference in gender,pathological type,length of hospital stay before surgery,intraoperative blood loss,or history of alcohol consumption.Multiple regression analysis demonstrated that age of 70 years or above,tumor stageⅢor above,operation time of 3 h,or history of diabetes and smoking were independent risk factors for postoperative nosocomial infection(P<0.01).CONCLUSION Age,tumor stage,operation time,diabetes history,and smoking history are independent risk factors for nosocomial infection in patients undergoing laparoscopic radical gastrectomy.When these risk factors are present,active measures should be taken to prevent nosocomial infection.
作者
王肖婷
何建秀
Xiao-Ting Wang;Jian-Xiu He(Yiwu Central Hospital,Yiwu 322000,Zhejiang Province,China)
出处
《世界华人消化杂志》
CAS
2021年第2期93-98,共6页
World Chinese Journal of Digestology
关键词
腹腔镜
胃癌根治术
医院感染
回归分析
危险因素
Laparoscopy
Radical gastrectomy
Nosocomial infection
Regression analysis
Risk factors
