皮肤外科门诊手术切口感染相关因素分析

【】目的 了解皮肤外科门诊手术切口感染发生情况,并分析其危险因素。方法 选择皮肤外科门诊手术患者930例,共1101个手术伤口,记录患者手术切口感染发生情况,采用自设的门诊手术切口感染危险因素调查表收集资料。结果 皮肤外科门诊手术患者切口感染发生率6.1%。Logistic回归分析显示,手术部位、糖尿病史、吸烟史、切口长度、拆线时间、术后疼痛、外用抗生素软膏、手术季节是皮肤外科门诊手术切口感染发生的危险因素。结论 皮肤外科门诊手术患者切口感染发生与自身、疾病手术、术后护理多种危险因素相关,应通过全面的危险因素评估,采取有效的预防措施,加强护理宣教,降低切口感染的发生。     

The effect of nurse‐performed preoperative skin preparation on postoperative surgical site infections in abdominal surgery

Aim. To determine the effect of preoperative skin preparation procedures performed by nurses on postoperative surgical site infection in abdominal surgery. Background. Despite all interventions, postoperative SSIs still greatly affect mortality and morbidity. Design. This is an experimental study. Methods. Procedures developed for nurse application of preoperative skin preparations were tested on a control group (n = 39) and study group (n = 43). Results. Only clinical routines for preoperative skin preparation were performed on the control group patients. Control group members’ skins were mostly prepared by shaving with a razor blade (41%). For the study group members, the researchers used the preoperative skin preparation procedure. Clippers were used to prepare 55·8% of study group members while 44·2% of them were not treated with the clipper because their wounds were clean. As a requirement of the procedure, all members of the study group had a chlorhexidine bath at least twice after being hospitalised and at least once a night before the operation under controlled conditions. In the group where chlorhexidine bath was not applied, the infection risk was found to be 4·76 times (95%CI = 1·20–18·83) greater even after corrections for age and gender had been made. The difference between control group and study group with respect to surgical site infections was also statistically significant (p < 0·05). Conclusion. Preoperative skin preparation using clipper on the nights before an operation and a 50 ml chlorhexidine bath excluding head area taken twice in the pre‐operative period are useful to reduce SSI during postoperative period. Relevance to clinical practice. We find that preoperative skin preparation using the procedures developed as a result of findings of this study is useful in reducing surgical site infection during the postoperative period.     

肝细胞癌切除术后影响手术部位感染的危险因素

目的探讨影响肝细胞癌(简称肝癌)切除术后手术部位感染的危险因素。方法选取2012年2月至2018年2月在四川大学华西医院肝脏外科行肝癌切除术的患者1 319例作为研究对象,收集、分析患者围术期临床资料,探讨影响术后手术部位感染的独立危险因素。结果 1 319例行肝癌切除术的患者中,82例(6.2%)发生手术部位感染,其中表浅切口感染37例(2.8%),深部切口感染16例(1.2%),器官/腔隙感染29例(2.2%)。围术期空腹血糖>6.1mmol/L、手术时间、术中出血量、术后胆漏是影响手术部位感染发生的独立危险因素。肝癌切除范围明显影响手术部位感染(P<0.05),以及器官/腔隙感染(P<0.05)。手术部位感染明显影响住院时间(P<0.05)和围术期病死率(P=0.021)。结论围术期血糖控制情况、手术时间、术中失血量、术后胆漏是影响手术部位感染的独立危险因素。肝癌切除范围明显影响手术部位感染,特别是影响器官/腔隙感染的独立危险因素。手术部位感染导致住院时间延长,围术期病死率升高。     

不同皮肤准备方法术后切口感染的研究及预防

目的比较术前不同皮肤准备方法和术后切口感染情况的关系,探讨科学、有效、简便的手术后感染预防措施。方法对可能影响术后切口感染的因素剃毛A、清洁方式B和备皮时间C3个因素进行析因设计,共获8种搭配;分析总感染率及A、B、C各组单独感染率。结果本次调查住院手术患者共1802例,发生手术感染146例,总感染率8．1％。其中,Ⅰ类手术978例,发生感染80例（8．2％）,Ⅱ类手术824例,发生感染66例（8．0％）;两种手术类型感染率比较差异无统计学意义（P〉0．05）;146例感染者中114例进行伤口分泌物、引流液病原微生物检查,送检率78．1％,共获得阳性病原菌65株,其中构成比前3位的是金葡菌（22．5％）、铜绿假单胞菌（15．3％）和大肠埃希菌（13．9％）;不同手术部位中发生感染最多的是胃肠道手术,42例（10．3％）,其次为骨科手术,37例（10．1％）。各组感染率差异有统计学意义（χ^2=24．540,P=0．01）,A181C1组（术前1d备皮,不剃毛,清水清洁）和A2BICI组（术前1d备皮,剃毛,清水清洁）感染率分别为12．4oA和13．6％,高于其他组（P〈0．05）;AI水平（即不剃毛组）术后切口感染率8．5％,A2水平（剃毛组）术后切i21感染率7．7％,两组差异无统计学意义（P〉0．05）;B1水平（清水清洁）术后感染率10．5％,B2水平（肥皂水清洁）术后感染率5．6％,两者差异有统计学意义（P〈0．05）;c1水平（术前1d）感染率为9．8％,C2水平（术前2h）感染率为6．4％,两者差异有统计学意义（P〉0．05）。对各组菌落总数进行方差分析,F=34．436,P=0．000,各组之间差异有统计学意义（P〈0．01）;各组经析因设计方差分析结果显示,B（清洁方式）、C（术前准备时间）单因素分析差异有统计学意义（P〈0．01）,A因素（剃毛与否）单因素分析差异无统计学意义（P〉0．05）;B与c、A与c之间存在交互作用（P〈0．01）,A与B之间无交互作用（P〉0．05）;A、B、C之间存在二级交互作用（P〈0．01）。结论手术前皮肤准备对于术后切VI感染预防具有重要意义。在进行术前备皮时,应优先考虑皮肤清洁,大量肥皂水或消毒水冲洗,彻底杀灭皮肤表面暂居致病菌;同时缩短备皮准备时间,减少细菌在皮肤表面的繁殖,预防切口感染;在保证术野清洁的前提下,尽量减少皮肤损伤,可以考虑剪毛或使用脱毛剂脱毛等方式,无须剃毛。     

5例神经外科患者手术部位感染原因分析

目的：探讨引起短期多例神经外科患者手术部位感染的可能原因。方法：回顾2013年2月1日至3月15日所有神经外科手术患者资料,进行相关暴露因素分析,探讨可能引起手术部位感染的危险因素。结果：“第五手术间”OR=4．07（95％CI=0．52～36．65）,第五手术间环境微生物采样除麻醉剂袖带菌落总数超标以外均符合国家要求;各“手术主刀医生”“手术参与者”的手术部位感染专率较神经外科手术部位平均感染率均无差异（P〉0．05）;“二次手术”OR=18．00（95％CI=2．00～180．00）。结论：“二次手术”是此次短期多例神经外科患者手术部位感染的高危因素;对其干预措施可由此入手,进一步探讨。     

Differences in clinical and cost-effectiveness between cefmetazole and flomoxef for the prevention of surgical site infection in elective colorectal surgery: A single-center,retrospective cohort study

IntroductionSurgical site infection (SSI) is associated with increased morbidity and mortality rates, postoperative length of stay (pLOS), and medical costs. In colorectal surgery, cefmetazole (CMZ) and flomoxef (FMOX) are predominantly used in Japan, and they have almost the same spectrum of antibiotic activity against SSI pathogens, and an approximately four-fold cost difference (CMZ: ～4$, FMOX: ～16$). However, the difference between these antibiotics in SSI prophylaxis in colorectal surgery remains poorly understood.MethodsWe performed a single-center retrospective cohort study to investigate the prophylactic effects of these antibiotics, pLOS, and hospitalization costs. Patients who underwent elective colorectal surgery between April 2016 and March 2020 were considered for this study.ResultsOf the 634 patients, 316 (49.8%) were eligible. The SSI rates in the CMZ and FMOX groups were 14.7% and 12.5%, respectively. The incidence of organ/space SSI was approximately two-fold lower in the CMZ group than in the FMOX group (4.4% vs. 9.4%). Multivariable regression analysis revealed that CMZ was not significantly related to SSI, with an adjusted odds ratio of 1.21 (95% confidence interval [CI]: 0.52–2.82) and did not induce a significant difference in pLOS (difference ratio: 0.951 [95% CI: 0.868–1.041]). Hospitalization costs were reduced in the CMZ group (difference ratio, 0.951 [95% CI: 0.907–0.998], p = 0.042). The sensitivity analysis also showed results similar to the above findings.ConclusionOur study showed that CMZ could be a cost-effective antibiotic with similar efficacy for SSI prophylaxis in colorectal surgery, compared with FMOX.     

术前剃毛与非剃毛对术后切口感染影响的系统评价

目的 系统评价剃毛与非剃毛对减少术后切口感染率的影响.方法 计算机检索国内外电子文献数据库,根据纳入标准进行筛选,并进行质量的评价,采用专用软件进行统计分析.结果 共纳入17个RCT,13个研究（n=4 104）采取清洁与剃毛的方式备皮,分析结果显示,实验组与对照组对减少切口感染率的差异有统计学意义;1个研究（n=382）采取剪毛与剃毛的备皮方式对减少切口感染率的差异没有统计学意义;3个研究（n=370）采取清洁与剃毛的备皮方式比较备皮前后消毒前细菌阳性率的差异没有统计学意义.结论 研究结果表明,采取清洁备皮的方式对减少切口感染率要优于剃毛组,采取清洁不去毛的方式引起的感染率要低于剃毛方式;没有证据表明采取剪毛的方式较剃毛的方式对减少切口感染有效.     

结肠直肠恶性肿瘤手术部位感染危险因素分析

目的评估结肠直肠恶性肿瘤手术部位感染(surgical site infection,SSI)发生率,探讨其危险因素。方法前瞻性调查于2012年9月—2013年9月在重庆医科大学附属第一医院行结肠直肠恶性肿瘤切除术的392例患者,分为SSI组90例和对照组302例,单因素和多因素分析手术部位感染危险因素。结果 SSI组90例,罹患率23.0%。单因素分析显示在手术持续时间>75%分位点、是否结肠造瘘、手术方式、手术切口类型、美国麻醉医师学会(ASA)评分两组差异有统计学意义(P<0.05),二元Logistic回归分析显示污染手术切口(P=0.016,OR=3.311)、手术持续时间>75%分位点(P=0.000,OR=3.017)、结肠造瘘(P=0.008,OR=2.642)、腹腔镜手术(P=0.016,OR=0.523)两组差异有统计学意义。结论手术持续时间>75%分位点、结肠造瘘和污染手术切口是结肠直肠恶性肿瘤切除术发生SSI独立的危险因素,而腹腔镜手术方式是保护性因素。     

Effect of head and body positioning on cerebral blood flow velocity in patients who underwent cranial surgery

Aim and objectives. The aim of this study was to investigate the effects of head and neck positions on the cerebral blood flow velocity by transcranial Doppler ultrasound in patients who underwent cranial surgery. Background. Inappropriate head elevation and body positioning in patients who undergo cranial surgery may affect cerebral blood flow and cerebral perfusion pressure. Designed. Experimental clinical study. Method. Our sample consisted of 38 patients who underwent cranial surgery between October 2009 and May 2010. The measurments of mean cerebral blood flow velocity were taken by the transcranial Doppler ultrasound through the temporal window. The mean cerebral blood flow velocity of the patients was measured in supine position with 0° and 30° head elevations, right and left lateral positions, right and left lateral positions with head flexion and extension. The measurements were taken before surgery and within 72 hours after surgery. Results. The mean cerebral blood flow velocity of the middle cerebral arteries was increased in head elevations from 0° to 30°, in right and lateral positions with 30° head elevations, but the velocity was decreased in head flexion and extension positions in preoperative and postoperative periods. Discussion. Head and body positioning, which is one of the nursing care activities, may affect intracranial pressure and cerebral perfusion pressure. Our results are similar with those of previous studies, which showed that head elevation did not affect the cerebral blood flow velocity. Relevance to clinical practice. By the results of this study, the head elevation of the patients, who underwent cranial surgery, should be 30° during the nursing care to provide optimum cerebral blood flow. Right and left lateral positioning is safe and recommended for these patients if there is no medical contraindication.     

围手术期口腔管理对结直肠癌术后手术部位感染的预防效果评价

目的 评价围手术期口腔管理预防结直肠癌术后手术部位感染(SSI)的效果.方法 选择2014年2月-2020年12月在本院接受根治性结直肠癌手术的698例患者为研究对象.其中563例患者接受了围手术期口腔管理干预,其余135例患者未接受干预.使用逐步进入的方法进行多变量logistic回归分析,考察患者发生SSI的独立危...     

Risk factors for surgical site infection after major hepatobiliary and pancreatic surgery

Major hepatobiliary and pancreatic (HP) surgeries are complex procedures associated with a high incidence of surgical site infection (SSI) and are commonly performed in patients with cancer in Japan. This study was performed to investigate the risk factors for SSI, including incisional and organ/space SSI, in HP surgery. The following procedures were included in the study: hepatectomy with and without biliary tract resection, pancreatectomy [pancreaticoduodenectomy (PD), others], and open cholecystectomy. In total, 735 patients were analyzed. The incidence of SSI was 17.8% (incisional, 5.2%; organ/space, 15.5%; both 2.9%). The highest incidence of SSI was observed in patients who underwent hepatectomy with biliary tract resection (39.1%), followed by pancreatectomy (PD, 28.8%; others, 29.8%). Almost all SSIs after these three procedures were classified as organ/space (39.1%, 25.0%, and 27.7%, respectively), and these procedures were risk factors for not only total SSI but also organ/space SSI in the multivariate analysis. An American Society of Anesthesiologists physical status of ≥3 was a risk factor for incisional SSI. Preoperative biliary drainage, prolonged surgery, concomitant surgery, and massive intraoperative bleeding were associated with SSI. In conclusion, the main type of SSI was organ/space SSI after HP surgery, and different risk factors were identified between organ/space and incisional SSI. Procedure-related factors and preoperative biliary drainage were independent risk factors for SSI. To prevent SSI, the indication for preoperative biliary drainage should be carefully evaluated in patients undergoing HP surgery.     

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.     

Port site infection in laparoscopic surgery: A review of its management

Laparoscopic surgery(LS), also termed minimal access surgery, has brought a paradigm shift in the approach to modern surgical care. Early postoperative recovery, less pain, improved aesthesis and early return to work have led to its popularity both amongst surgeons and patients. Its application has progressed from cholecystectomies and appendectomies to various other fields including gastrointestinal surgery, urology, gynecology and oncosurgery. However, LS has its own package of complications. Port site infection(PSI), although infrequent, is one of the bothersome complications which undermine the benefits of minimal invasive surgery. Not only does it add to the morbidity of the patient but also spoils the reputation of the surgeon. Despite the advances in the field of antimicrobial agents, sterilization techniques, surgical techniques, operating room ventilation, PSIs still prevail. The emergence of rapid growing atypical mycobacteria with multidrug resistance, which are the causative organism in most of the cases, has further compounded the problem. PSIs are preventable if appropriate measures are taken preoperatively, intraoperatively and postoperatively. PSIs can often be treated non-surgically, with early identification and appropriate management. Macrolides, quinolones and aminoglycosides antibiotics do show promising activity against the atypical mycobacteria. This review article highlights the clinical burden, presentations and management of PSIs in LS as shared by various authors in the literature. We have given emphasis to atypical mycobacteria, which are emerging as a common etiological agent for PSIs in LS. Although the existing literature lacks consensus regarding PSI management, the complication can be best avoided by strictly abiding by the commandments of sterilization techniques of the laparoscopic instruments with appropriate sterilizing agent.     

乳腺Ⅰ类切口手术部位感染危险因素分析

摘要 目的 研究乳腺Ⅰ类切口手术部位感染相关危险因素,为有效防控提供参考。方法 通过回顾性调查方法,对某医院住院行乳腺Ⅰ类切口手术患者手术部位感染相关因素进行分析。结果 共调查乳腺I类切口手术患者2 846例,其中发生手术部位感染46例,感染率为1.62％。Logistic回归模型分析显示,恶性肿瘤、放疗、血清白蛋白浓度＜30 g/L、切口≥10 cm、切口引流、BMI≥25 kg/m2等因素是乳腺Ⅰ类切口手术部位感染的独立危险因素(P＜0.05)。结论 乳腺Ⅰ类切口手术部位感染与多因素相关,应针对相关危险因素采取有效防控措施。     

Helical CT and its three-dimensional image: Application for image-guided surgery in middle cranial fossa approach

Summary

We describe our method to design a safe approach to the target region in surgery using helical (spiral) computed tomography (CT) and its three-dimensional images. Twenty-five patients with acoustic neuroma in the internal auditory canal underwent helical CT examination before surgery. Three-dimensional images were made and the internal auditory canal was identified. We exposed the internal auditory canal through the middle cranial fossa referring to these images. We also applied this method to four cases of vestibular nerve section. These images permitted safe, accurate image-guided surgery in these 29 procedures. Helical CT enables reconstruction of usable 3-D images and those images help us to perform surgery with minimal invasion.     

外科切口感染病原菌及耐药性研究

目的：探讨外科切口感染菌分布及耐药性，指导临床医生用药。方法：对368例外科住院病人术后切口感染病原菌的分布及耐药性进行回顾性调查，结果：368例术后切口感染标本，共分离感染菌445株，其中，居前5位的感染病原体依次为：金黄色葡萄球菌、凝固酶阴性葡萄球菌，铜绿假单胞菌，大肠埃希菌，肠球菌，占所有感染细菌的89．2％，感染菌多重耐药现象严重。结论：细菌耐药性是引起术后感染，治愈困难的重要原因之一，加强感染菌耐性监测，能降低术后感染的发生防止医院内术后感染的爆发流行。