Barana L, Gastaldo L, Maestri F, Sgarella A, Rescigno G, Prati U, Berti A, Mourad Z, Nazari S, Zonta A
IRCCS Policlinico San Matteo, Dipartimento di Chirurgia, Università di Pavia.
Minerva Chir. 1992 Jul;47(13-14):1177-87.
Postoperative infections are the most frequent complications in surgery and are the commonest cause of the lengthening of hospital stay. The purpose of this study is to prospectively evaluate the incidence and predisposing factors of postoperative infections in 1396 surgical patients admitted to our Institute from 1984 to 1988. Patients undergoing minor surgical procedures (wound less than 2 cm) were excluded from the study. Patients were evaluated daily during hospital stay for onset of infections and results recorded on data sheet. Hemocultures in septic patients and samples of exudate at site of infection were taken whenever possible for aerobic and anaerobic cultures. 368 patients (26.36%) had at least one postoperative septic complication; (79 of them [5.65%] had two or more infections). The following infections were recorded: wound infections: 148 (10.60%); respiratory tract infections: 144 (10.31%); urinary tract infections 125 (8.95%); miscellaneous infections 11 (0.78%); thrombophlebitis 23 (1.64%); FUO 10 (0.71%). The most important predisposing factor for wound infection was endogenous contamination (wound infections: 18/499 [3.60%] in clean, 42/594 [7.67%] in potentially contaminated, 57/217 [26.26%] in contaminated and 31/86 [36.04%] in dirty operations). The duration of the anaesthesia was found to correlate with an increased incidence of respiratory tract infections (4.49% anaesthesia less than 60 min; 7.21% anaesthesia greater than 60 less than 120 min; 15.31% greater than 120 min anaesthesia). Urinary infections were more frequent when the patients where catheterized at least once in the postoperative period (24.86% vs 3.2%).
术后感染是外科手术中最常见的并发症,也是住院时间延长的最常见原因。本研究的目的是前瞻性评估1984年至1988年期间入住我院的1396例外科手术患者术后感染的发生率及易感因素。接受小手术(伤口小于2厘米)的患者被排除在研究之外。患者在住院期间每天接受感染发病情况评估,并将结果记录在数据表上。只要有可能,对败血症患者进行血培养,并采集感染部位的渗出液样本进行需氧和厌氧培养。368例患者(26.36%)至少发生了一种术后败血症并发症;其中79例(5.65%)发生了两种或更多种感染。记录到的感染情况如下:伤口感染:148例(10.60%);呼吸道感染:144例(10.31%);尿路感染125例(8.95%);其他感染11例(0.78%);血栓性静脉炎23例(1.64%);不明原因发热10例(0.71%)。伤口感染最重要的易感因素是内源性污染(伤口感染:清洁手术中为18/499 [3.60%],可能污染手术中为42/594 [7.67%],污染手术中为57/217 [26.26%],污染严重手术中为31/86 [36.04%])。发现麻醉时间与呼吸道感染发生率增加相关(麻醉时间小于60分钟时为4.49%;麻醉时间大于60分钟小于120分钟时为7.21%;麻醉时间大于120分钟时为15.31%)。术后至少导尿一次的患者尿路感染更常见(24.86%对3.2%)。