Retrospective analysis of related factors of infection after cesarean section
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摘要:目的 回顾性分析剖宫产术后感染的相关因素。方法 随机抽取行剖宫产的产妇病历347份, 以术后感染为结局指标，应用Logistic单因素与多因素分析剖宫产术后感染的独立高危因素，以及不同给药方案(包括给药品种、给药时间、给药时机)对术后感染的影响。结果 阴道试产、术中出血量大、产后出血量大以及盆腔粘连是术后感染的独立高危因素(P < 0.05)。升级用药组的术后感染率高于常规给药组(P < 0.05)。用药时间≤24 h组与>24 h组、给药时机为断脐后组与术前组，其术后感染的差异无统计学意义(P>0.05)。结论 术中出血量大、阴道试产、盆腔粘连等高危因素以及预防性抗菌药物使用与剖宫产术后感染均相关。Abstract:Objective To retrospectively analyze the related factors of infection after cesarean section.Methods Totally 347 medical records of women with cesarean section were randomly collected. Taking postoperative infection as the outcome index, the independent high- risk factors of infection after cesarean section were analyzed by Logistic single factor and multiple factors analysis, and the effects of different therapeutic regimens (including dosage varieties, drug use time, drug use timing) on infection after cesarean section were analyzed.Results Vaginal trial delivery, large amount of intra- operative bleeding, large amount of postpartum bleeding and pelvic adhesion were the independent high- risk factors for postoperative infection (P < 0.05). The infection rate of the up- graded medication group was higher than that of routine medication group (P < 0.05). There was no significant difference in infection after operation between drug use time less than or equal to 24 h group and over 24 h group, and drug use timing after umbilical cord amputation group and before operation group (P>0.05).Conclusion High- risk factors such as intraoperative bleeding, vaginal trial delivery, pelvic adhesions and prophylactic antibiotics use are associated with infection after cesarean section.
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Keywords:
- cesarean section /
- antibiotics /
- risk factors /
- postoperative infection
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表 1 剖宫产术后感染高危因素单因素分析
高危因素 B S. E. Wald df Sig Exp(B) 95%CI for Exp(B) 下限 上限 手术时间长(>1 h) 2.254 1.086 4.309 1 0.038 9.530 1.134 80.027 术中出血量大(>500 mL) 2.873 0.751 14.652 1 0 17.690 4.063 77.034 产后出血量大 1.985 0.790 6.315 1 0.012 7.280 1.548 34.217 侵入检查次数多 1.201 0.448 7.181 1 0.007 3.320 1.381 7.995 阴道试产 1.920 0.283 45.887 1 0 6.820 3.914 11.891 盆腔粘连 2.416 1.075 5.052 1 0.025 11.200 1.362 92.078 
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表 2 剖宫产术后感染高危因素多因素分析
高危因素 B S. E. Wald df Sig Exp(B) 95%CI for Exp(B) 下限 上限 手术时间长(>1 h) 2.170 1.200 3.268 1 0.071 8.761 0.833 92.137 术中出血量大(>500 mL) 2.730 0.807 11.437 1 0.001 15.340 3.152 74.659 产后出血量大 1.905 0.890 4.579 1 0.032 6.719 1.174 38.468 侵入检查次数多 0.098 0.540 0.330 1 0.856 1.103 0.383 3.176 阴道试产 2.288 0.320 51.055 1 0 9.853 5.260 18.454 盆腔粘连 3.194 1.090 8.594 1 0.003 24.387 2.882 206.331
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表 3 剖宫产用药方案单因素分析
项目 B S. E. Wald df Sig Exp(B) 95%CI for Exp(B) 下限 上限 用药品种 2.285 0.327 48.94 1 0 9.822 5.179 18.629 用药时间 0.334 0.260 1.651 1 0.199 1.397 0.839 2.327 用药时机 -0.697 0.404 2.977 1 0.084 0.498 0.226 1.099
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表 4 剖宫产用药方案多因素分析
项目 B S. E. Wald df Sig Exp(B) 95%CI for Exp(B) 下限 上限 用药品种 2.250 0.330 46.505 1 0 9.486 4.969 18.110 用药时间 0.300 0.289 1.077 1 0.299 1.350 0.766 2.378 用药时机 -0.213 0.482 0.195 1 0.659 0.808 0.314 2.081
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