老年患者

Analysis of six common surgical site infections and related risk factors in elderly patients after gastrointestinal surgeryHe Xingzheng, Zhang Chuanguo, Cai Yujian

摘要:

目的 探讨老年患者6种常见胃肠道手术后手术部位感染(SSI)情况及相关危险因素。方法 回顾性分析2014年12月—2019年11月某院普通外科手术治疗的1 730例患者的临床资料,其中胆囊切除术350例、结肠手术555例、食道手术132例、胃手术364例、直肠手术179例、小肠手术150例。收集患者临床资料,比较患者住院期间SSI的发生率,分析SSI发生相关危险因素。结果 1 730例胃肠道手术患者中,切口浅部组织感染111例(6.4%),切口深部组织感染和器官/腔隙感染93例(5.4%),总体SSI发生率204例(11.8%)。其中胆囊切除术患者SSI发生率最低(3.4%),食道手术患者SSI发生率最高(18.9%)。按手术类型分层后,术中输血、手术时间长、抗糖尿病药、手术切口III/IV类是5种以上常见胃肠手术患者SSI的共同危险因素(均P<0.05)。多因素logistic回归分析结果示,年龄、术中输血、抗糖尿病药、类固醇类药物、手术时间、手术切口III/IV类、ASA分级≥三级、急诊手术是常见胃肠道手术患者SSI的重要危险因素(P<0.05),腹腔镜手术是SSI的保护因素(P<0.05)。结论 年龄、术中输血、抗糖尿病药、类固醇类药物、手术时间、手术切口III/IV类、ASA分级≥三级、急诊手术是常见胃肠道手术患者SSI的重要危险因素,腹腔镜手术是SSI的保护因素。

Abstract:

Objective: To explore the six common surgical site infections (SSI) and related risk factors in elderly patients after gastrointestinal surgery. Methods: The clinical data of 1,730 patients treated with general surgery in our hospital from December 2014 to November 2019 were retrospectively analyzed, including 350 cases of cholecystectomy, 555 cases of colon surgery, 132 cases of esophageal surgery, 364 cases of gastric surgery, 179 cases of rectal surgery and 150 cases of small bowel surgery. Collect the patient"s age, gender, previous medical history, type of surgery, operation time, intraoperative blood transfusion, anesthesia method, whether laparoscopic surgery, emergency surgery, taking immunosuppressive drugs, anti-diabetic drugs, steroids, surgical incision classification and American College of Anesthesiologists (ASA) classification and other clinical data. Observe the incidence of SSI during the hospitalization of patients, and use multivariate logistic regression to analyze the risk factors of SSI. Results: Of the 1,730 patients undergoing gastrointestinal surgery, 111 (6.4%) were infected by superficial incisions, 93 (5.4%) were infected by deep incisions and organs / spaces, and 204 (11.8%) were overall SSI. Among them, patients with cholecystectomy had the lowest incidence of SSI (3.4%), and patients with esophageal surgery had the highest incidence of SSI (18.9%). After stratified according to the type of operation, intraoperative blood transfusion, long operation time, antidiabetic drugs, and surgical incision III / IV were common risk factors for SSI in more than five common gastrointestinal surgery patients (P<0.05). Multivariate logistic regression analysis results show that age, intraoperative blood transfusion, antidiabetic drugs, steroids, operation time, surgical incision III / IV, ASA grade ≥3, and emergency surgery were important risk factors for SSI in common gastrointestinal surgery Risk factors (P<0.05). Laparoscopic surgery was a protective factor for SSI (P<0.05). Conclusion: Age, intraoperative blood transfusion, antidiabetic drugs, steroids, operation time, surgical incision III / IV, ASA grade ≥ 3, emergency surgery were important risk factors for SSI in patients with common gastrointestinal surgery, and laparoscopic surgery was SSI Protection factor.