本文選題：SSI + 危險(xiǎn)因素�。� 參考：《新鄉(xiāng)醫(yī)學(xué)院》2015年碩士論文

【摘要】：背景：手術(shù)部位感染(Surgical site infection, SSI)是一種普遍的衛(wèi)生保健相關(guān)的感染,在美國的整體手術(shù)并發(fā)癥中占2-5%。在我國部分地區(qū)胸部手術(shù)術(shù)后手術(shù)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(shù)后手術(shù)部位感染的發(fā)生率為0.6%-6.6%,但是梁偉濤等的調(diào)查分析胸骨正中切口感染率則是1.4%,尤顥等[5]的研究結(jié)果為心臟直視手術(shù)術(shù)后手術(shù)部位感染發(fā)病率2.87%,不同于其他報(bào)道。SSI相關(guān)的發(fā)病率和死亡率均增加,從表面?zhèn)诟腥鞠嚓P(guān)的切口液化到有生命危險(xiǎn)的重癥膿毒癥,并且發(fā)生手術(shù)部位感染的風(fēng)險(xiǎn)因素是復(fù)雜多樣的。在基于臨床實(shí)踐的觀察研究中可以發(fā)現(xiàn)多種風(fēng)險(xiǎn)因素和其他影響因素,對(duì)于更大范圍的臨床研究來說,對(duì)SSI發(fā)生的研究并不只局限于特定的某一風(fēng)險(xiǎn)因素。手術(shù)部位感染作為醫(yī)療保健系統(tǒng)的一個(gè)持續(xù)性挑戰(zhàn)和負(fù)擔(dān),需要我們對(duì)其發(fā)生機(jī)制和促進(jìn)因素有更準(zhǔn)確和特異性的判斷,并且要對(duì)當(dāng)前預(yù)防措施的效能有精確評(píng)估。目的：通過對(duì)心臟外科直視術(shù)后手術(shù)部位感染發(fā)生的相關(guān)風(fēng)險(xiǎn)因素,可能的具體機(jī)制,現(xiàn)行的預(yù)防和處理措施進(jìn)行更準(zhǔn)確和全面的評(píng)估,為臨床實(shí)踐中對(duì)SSI的認(rèn)識(shí)、預(yù)防和治療提供精確可靠的科學(xué)基礎(chǔ),并探索建立心臟外科病人術(shù)后手術(shù)部位感染的預(yù)測(cè)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(jìn)行直視下心臟手術(shù)1384例,其中術(shù)后手術(shù)部位感染患者51例,與同期未發(fā)生手術(shù)部位感染的患者按1：2配比法進(jìn)行相關(guān)風(fēng)險(xiǎn)因素分析,涉及的風(fēng)險(xiǎn)因素包括性別、年齡、體重指數(shù)、吸煙、糖尿病、手術(shù)時(shí)間等,數(shù)據(jù)使用SSPS 22.0軟件分析。結(jié)果：全部1384例心臟直視手術(shù)后手術(shù)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(nèi)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(rèn)為,手術(shù)時(shí)間(2.5小時(shí))、術(shù)后ICU時(shí)間(2天)、術(shù)后發(fā)熱(3天,38.5℃)是SSI的獨(dú)立相關(guān)因素(P0.05)。結(jié)論：心臟直視術(shù)后手術(shù)部位感染發(fā)生率較高,其發(fā)生與以下因素有關(guān)：糖尿病、手術(shù)時(shí)間、術(shù)后ICU時(shí)間、術(shù)后發(fā)熱等。除常規(guī)預(yù)防措施外,減少手術(shù)時(shí)間,改進(jìn)術(shù)后病人ICU治療與護(hù)理可減少SSI發(fā)生幾率,病人術(shù)后ICU停留時(shí)間增加和術(shù)后發(fā)熱可成為手術(shù)部位感染的預(yù)測(cè)或診斷指標(biāo)。可根據(jù)心臟外科手術(shù)的特點(diǎn)建立手術(shù)部位感染的預(yù)測(cè)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，

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