發(fā)布時間：2018-05-12 03:09

  本文選題：SSI + 危險因素　； 參考：《新鄉(xiāng)醫(yī)學院》2015年碩士論文

【摘要】：背景：手術部位感染(Surgical site infection, SSI)是一種普遍的衛(wèi)生保健相關的感染,在美國的整體手術并發(fā)癥中占2-5%。在我國部分地區(qū)胸部手術術后手術部位感染的發(fā)病率為5.87%。而更大范圍的研究表明心臟術后手術部位感染的發(fā)生率為0.6%-6.6%,但是梁偉濤等的調查分析胸骨正中切口感染率則是1.4%,尤顥等[5]的研究結果為心臟直視手術術后手術部位感染發(fā)病率2.87%,不同于其他報道。SSI相關的發(fā)病率和死亡率均增加,從表面?zhèn)诟腥鞠嚓P的切口液化到有生命危險的重癥膿毒癥,并且發(fā)生手術部位感染的風險因素是復雜多樣的。在基于臨床實踐的觀察研究中可以發(fā)現(xiàn)多種風險因素和其他影響因素,對于更大范圍的臨床研究來說,對SSI發(fā)生的研究并不只局限于特定的某一風險因素。手術部位感染作為醫(yī)療保健系統(tǒng)的一個持續(xù)性挑戰(zhàn)和負擔,需要我們對其發(fā)生機制和促進因素有更準確和特異性的判斷,并且要對當前預防措施的效能有精確評估。目的：通過對心臟外科直視術后手術部位感染發(fā)生的相關風險因素,可能的具體機制,現(xiàn)行的預防和處理措施進行更準確和全面的評估,為臨床實踐中對SSI的認識、預防和治療提供精確可靠的科學基礎,并探索建立心臟外科病人術后手術部位感染的預測模型的可行性。方法：回顧性分析某三甲醫(yī)院心血管外科2011年1月至2014年10月進行直視下心臟手術1384例,其中術后手術部位感染患者51例,與同期未發(fā)生手術部位感染的患者按1：2配比法進行相關風險因素分析,涉及的風險因素包括性別、年齡、體重指數(shù)、吸煙、糖尿病、手術時間等,數(shù)據(jù)使用SSPS 22.0軟件分析。結果：全部1384例心臟直視手術后手術部位感染患者51例,感染率為3.68%,其中切口淺表部位、深部及縱膈內感染的比例分別為84.31%(43例)、13.73%(7例)及1.96%(1例)。多因素條件logistic回歸分析認為,手術時間(2.5小時)、術后ICU時間(2天)、術后發(fā)熱(3天,38.5℃)是SSI的獨立相關因素(P0.05)。結論：心臟直視術后手術部位感染發(fā)生率較高,其發(fā)生與以下因素有關：糖尿病、手術時間、術后ICU時間、術后發(fā)熱等。除常規(guī)預防措施外,減少手術時間,改進術后病人ICU治療與護理可減少SSI發(fā)生幾率,病人術后ICU停留時間增加和術后發(fā)熱可成為手術部位感染的預測或診斷指標�？筛鶕�(jù)心臟外科手術的特點建立手術部位感染的預測模型。
[Abstract]:Background: Surgical site infection, SSI), a surgical site infection, is a common health care related infection, accounting for 2-5% of the overall surgical complications in the United States. The incidence of postoperative site infection in some parts of China is 5.87. A larger study showed that the incidence of postoperative infection was 0.6-6.6, but the infection rate of median sternum incision was 1.4 and you Hao et al. [5] was the operative part of open heart surgery. The incidence of site infection was 2.87, which was different from other reports. SSI-related morbidity and mortality increased, From wound liquefaction associated with superficial wound infection to life-threatening severe sepsis, the risk factors for surgical site infection are complex and varied. A variety of risk factors and other influencing factors can be found in observational studies based on clinical practice. For a wider range of clinical studies, the research on the occurrence of SSI is not limited to a particular risk factor. As a persistent challenge and burden of the health care system, surgical site infection requires us to have a more accurate and specific judgment on its pathogenesis and promotion factors, and to accurately evaluate the effectiveness of current preventive measures. Objective: to evaluate more accurately and comprehensively the risk factors, possible mechanism, prevention and treatment of postoperative infection in open heart surgery, so as to make a better understanding of SSI in clinical practice. To provide accurate and reliable scientific basis for prevention and treatment, and to explore the feasibility of predicting surgical site infection in cardiac surgery patients. Methods: from January 2011 to October 2014, 1384 patients who underwent open vision heart surgery in cardiovascular surgery in a third Class A Hospital were retrospectively analyzed, including 51 patients with postoperative site infection. The data were analyzed by SSPS 22.0 software, including sex, age, body mass index, smoking, diabetes, operation time and so on. Results: there were 51 cases (3.68%) of all 1384 patients with infection after open heart surgery. The infection rates in superficial, deep and mediastinal areas of incision were 84.31 and 13.737.37, respectively. Multivariate conditional logistic regression analysis showed that the operation time was 2.5 hours, the postoperative ICU time was 2 days, and the postoperative fever was 38.5 鈩，

本文編號：1876848