胰十二指肠切除术后感染的危险因素分析与防护对策
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摘要
目的:探讨胰十二指肠切除术(PD)后感染的危险因素和护理预防。方法:回顾性分析2012年3月~2017年7月我院肝胆外科70例行PD术患者的临床资料,根据患者术后是否发生感染分为感染组38例和未感染组32例,观察感染组患者感染发生部位分布及细菌培养类型,收集患者的术前、术中及术后等一般资料并进行单因素分析,并将有统计学意义单因素进行多元logistic回归分析,探讨PD术后感染发生的危险因素。结果:感染组患者感染部位主要为腹腔、呼吸道、切口、泌尿系统和深静脉导管,引起患者感染的菌种主要为:大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、金黄色葡萄球菌。两组患者在术前TB、糖尿病、手术时间、术后白蛋白、术后胰瘘及术后胃排空延迟等方面比较,差异具有统计学意义(P<0.05),术前高TB、糖尿病、术后低白蛋白、术后胰瘘等为PD术后发生感染的独立危险因素(P<0.05)。结论:术前高胆红素血症、术前糖尿病、术后低白蛋白、术后胰瘘等是PD术后患者发生感染的独立危险因素,围术期根据感染发生的危险因素制定规范护理措施。
Objective: To explore the risk factors and nursing prevention of infections after pancreatoduodenectomy( PD). Methods: To make a retrospective analysis of clinical data of a total of 70 patients undergoing PD in the department of hepatobiliary surgery of our hospital from March 2012 to July 2017.The patients were divided into infected group of 38 cases and uninfected group of 32 cases in terms of postoperative infections. The distribution of infection sites and type of bacterial culture were observed and the preoperative,intraoperative and postoperative general data was collected for single factor analysis.In addition,a multivariate logistic regression analysis was made for the statistically significant single factors to explore the risk factors of infections after PD.Results: The infection sites of patients in the infected group mainly included abdominal cavity,respiratory tract,incision,urinary system and deep venous catheter. The main pathogens causing infections were Escherichia coli,Klebsiella pneumoniae,Pseudomonas aeruginosa,and Staphylococcus aureus. The preoperative TB,diabetes,operation time,postoperative albumin,postoperative pancreatic fistula and postoperative delayed gastric emptying were compared between the two groups,and the differences were statistically significant( P < 0. 05). The preoperative TB,diabetes,postoperative albumin and postoperative pancreatic fistula were the risk factors for infections after PD( P < 0. 05). Conclusion: The preoperative hyperbilirubinemia,preoperative diabetes,postoperative hypoalbuminemia and postoperative pancreatic fistula are independent risk factors for infection after PD. The standardized perioperative nursing measures should be formulated according to the risk factors for infection.
Objective: To explore the risk factors and nursing prevention of infections after pancreatoduodenectomy( PD). Methods: To make a retrospective analysis of clinical data of a total of 70 patients undergoing PD in the department of hepatobiliary surgery of our hospital from March 2012 to July 2017.The patients were divided into infected group of 38 cases and uninfected group of 32 cases in terms of postoperative infections. The distribution of infection sites and type of bacterial culture were observed and the preoperative,intraoperative and postoperative general data was collected for single factor analysis.In addition,a multivariate logistic regression analysis was made for the statistically significant single factors to explore the risk factors of infections after PD.Results: The infection sites of patients in the infected group mainly included abdominal cavity,respiratory tract,incision,urinary system and deep venous catheter. The main pathogens causing infections were Escherichia coli,Klebsiella pneumoniae,Pseudomonas aeruginosa,and Staphylococcus aureus. The preoperative TB,diabetes,operation time,postoperative albumin,postoperative pancreatic fistula and postoperative delayed gastric emptying were compared between the two groups,and the differences were statistically significant( P < 0. 05). The preoperative TB,diabetes,postoperative albumin and postoperative pancreatic fistula were the risk factors for infections after PD( P < 0. 05). Conclusion: The preoperative hyperbilirubinemia,preoperative diabetes,postoperative hypoalbuminemia and postoperative pancreatic fistula are independent risk factors for infection after PD. The standardized perioperative nursing measures should be formulated according to the risk factors for infection.
引文
[1]李学璐,朱丹丹,杨春明,等.微创胰十二指肠切除术新进展[J].中国普通外科杂志,2015,24(3):402-407.
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[11]李庆东,邓和军.胰十二指肠切除术后严重并发症的临床分析[J].检验医学与临床,2015,12(11):1604-1605.
[12]邵卓,杨件新,金钢,等.个体化快速康复措施对胰十二指肠切除术后围手术期并发症的影响[J].中华胰腺病杂志,2015,15(3):163-168.
[13]袁晟光,梁科伟,刘杰,等.术前不同引流方式减黄对梗阻性黄疸大鼠部分肝切除术后肝功能和肝再生的影响[J].山东医药,2012,52(48):42-45.
[14]岳平,张金铎,把永江,等.胆管恶性梗阻术前减黄的现状及进展[J].中国普外基础与临床杂志,2017,24(5):644-648.
[15]郑四鸣,陆才德,周新华,等.糖尿病对胰腺癌胰十二指肠切除术后并发症的影响[J].中华普通外科杂志,2013,28(9):649-653.
[16]端传友,王新波.糖尿病对胰腺癌患者胰十二指肠切除术后早期并发症的影响[J].中国综合临床,2016,32(2):160-164.
[17]孙建军,陈敏胜.影响胰十二指肠切除术后早期并发症的危险因素分析[J].中国医师进修杂志,2012,35(5):24-27.
[18]王义涛,郭涛,齐浩龙,等.肠内营养与肠内营养联合肠外营养在胰十二指肠切除术后患者中的应用比较[J].临床外科杂志,2015,23(3):192-194.
[19]陆建文,吕毅,殷国志,等.胰十二指肠切除术后患者早期肠内营养与肠外营养的比较[J].中华肝胆外科杂志,2015,21(10):686-690.
[20]邢进,尚东.胰十二指肠切除术后感染相关危险因素分析[J].大连医科大学学报,2015,37(2):165-168.
[21]陈正民,黄强,刘臣海.胰十二指肠切除术后胰瘘的危险因素分析[J].重庆医学,2015,44(29):4156-4158.
[2]徐宜梅,李翔.腹腔镜辅助下胰十二指肠切除术的配合技巧[J].护理实践与研究,2013,10(1):139-141.
[3]陈东,陈伟,殷晓煜,等.胰十二指肠切除术后并发症发生的相关因素分析[J].中华消化外科杂志,2012,11(4):331-334.
[4]杨海军,原晓勇.胰十二指肠切除术后早期并发症危险因素分析[J].山东医药,2013,53(2):71-73.
[5]刘媛,谭锦风,付小艳,等.快速康复外科理念在胰十二指肠切除术围术期护理中的应用[J].护理实践与研究,2016,13(18):63-64.
[6]汪明庆,熊茂明,胡孔旺,等.改良Child术式预防胰十二指肠切除术后并发症的应用研究[J].肝胆外科杂志,2014,22(1):30-33.
[7]俞士卉.胰十二指肠切除术后严重并发症的观察与护理对策[J].安徽医药,2014,18(1):193-195.
[8]Mohammed S,Evans C,Vanburen G,et al.Treatment of bacteriobilia decreases wound infection rates after pancreaticoduodenectomy[J].HPB,2013,16(6):592-598.
[9]王妮妮,朱国玲,许文青,等.胰十二指肠切除术后出血的观察和护理策略[J].中华全科医学,2014,12(12):2027-2028.
[10]朱宏达,马尘超,白岳青,等.胰十二指肠切除术后腹腔并发症发生及引流留置时间预测[J].肝胆胰外科杂志,2014,26(5):372-375.
[11]李庆东,邓和军.胰十二指肠切除术后严重并发症的临床分析[J].检验医学与临床,2015,12(11):1604-1605.
[12]邵卓,杨件新,金钢,等.个体化快速康复措施对胰十二指肠切除术后围手术期并发症的影响[J].中华胰腺病杂志,2015,15(3):163-168.
[13]袁晟光,梁科伟,刘杰,等.术前不同引流方式减黄对梗阻性黄疸大鼠部分肝切除术后肝功能和肝再生的影响[J].山东医药,2012,52(48):42-45.
[14]岳平,张金铎,把永江,等.胆管恶性梗阻术前减黄的现状及进展[J].中国普外基础与临床杂志,2017,24(5):644-648.
[15]郑四鸣,陆才德,周新华,等.糖尿病对胰腺癌胰十二指肠切除术后并发症的影响[J].中华普通外科杂志,2013,28(9):649-653.
[16]端传友,王新波.糖尿病对胰腺癌患者胰十二指肠切除术后早期并发症的影响[J].中国综合临床,2016,32(2):160-164.
[17]孙建军,陈敏胜.影响胰十二指肠切除术后早期并发症的危险因素分析[J].中国医师进修杂志,2012,35(5):24-27.
[18]王义涛,郭涛,齐浩龙,等.肠内营养与肠内营养联合肠外营养在胰十二指肠切除术后患者中的应用比较[J].临床外科杂志,2015,23(3):192-194.
[19]陆建文,吕毅,殷国志,等.胰十二指肠切除术后患者早期肠内营养与肠外营养的比较[J].中华肝胆外科杂志,2015,21(10):686-690.
[20]邢进,尚东.胰十二指肠切除术后感染相关危险因素分析[J].大连医科大学学报,2015,37(2):165-168.
[21]陈正民,黄强,刘臣海.胰十二指肠切除术后胰瘘的危险因素分析[J].重庆医学,2015,44(29):4156-4158.