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在埃塞俄比亚西北部德布雷塔伯尔综合医院接受剖宫产的妇女中,手术部位感染及其相关因素:基于医院的横断面研究。

Surgical site infection and associated factors among women underwent cesarean delivery in Debretabor General Hospital, Northwest Ethiopia: hospital based cross sectional study.

机构信息

Department of Midwifery College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.

出版信息

BMC Pregnancy Childbirth. 2019 Aug 29;19(1):317. doi: 10.1186/s12884-019-2442-0.

Abstract

BACKGROUND

Cesarean section rates have been increasing dramatically during the past three decades and surgical site infections are becoming a leading cause of morbidity and mortality among women undergoing cesarean deliveries. However there is lack of sound evidence on both the magnitude of the problem and the associated factors in developing countries including Ethiopia. The purpose of this study was to assess proportion of surgical site infection and associated factors among women undergoing cesarean delivery in Debretabor General Hospital.

METHODS

An institution based cross sectional study was conducted from May to December / 2017. All women delivered by cesarean section in Debretabor General Hospital during data collection period were our study population. Data were collected using Pre-tested, semi-structured questionnaire/ data extraction tool and post discharge phone follow up and analyzed using SPSS version 20. Logistic regression model was used to determine the association of independent variables with the outcome variable and odds ratios with 95% confidence interval were used to estimate the strength of the association.

RESULTS

Proportion of surgical site infection among cesarean deliveries was about 8% (95%Cl: 5.4, 11.6). Pregnancy induced hypertension (AOR = 4.75, 95%CI: 1.62, 13.92), chorioaminitis (AOR = 4.37, 95%CI: 1.53, 12.50), midline skin incision (AOR = 5.19, 95% CI: 1.87, 14.37 and post-operative hemoglobin less than 11 g/deciliter (AOR = 5.28, 95%CI: 1.97, 14.18) were significantly associated with surgical site infection.

CONCLUSIONS

Pregnancy induced hypertension, chorioaminitis, midline skin incision and post-operative hemoglobin of less than 11 g/deciliter were independent factors associated with surgical site infection. Cesarean deliveries with concomitant pregnancy induced hypertension, chorioaminitis and post-operative anemia needs special care and follow up until surgical site infection is ruled out. It is also advisable to reduce generous midline skin incision and better replaced with pfannensteil incision.

摘要

背景

在过去的三十年中,剖宫产率显著增加,手术部位感染成为剖宫产产妇发病率和死亡率的主要原因。然而,在包括埃塞俄比亚在内的发展中国家,关于问题的严重程度和相关因素缺乏可靠的证据。本研究旨在评估 Debretabor 综合医院剖宫产产妇手术部位感染的比例及其相关因素。

方法

这是一项于 2017 年 5 月至 12 月进行的基于机构的横断面研究。所有在数据收集期间行剖宫产术的产妇均为研究对象。使用经过预测试的半结构式问卷/数据提取工具收集数据,并在出院后通过电话进行随访,采用 SPSS 20 版进行分析。使用逻辑回归模型确定自变量与结局变量的相关性,使用比值比及其 95%置信区间来估计相关性的强度。

结果

剖宫产手术部位感染的比例约为 8%(95%CI:5.4%,11.6%)。妊娠高血压(AOR=4.75,95%CI:1.62,13.92)、绒毛膜羊膜炎(AOR=4.37,95%CI:1.53,12.50)、中线皮肤切口(AOR=5.19,95%CI:1.87,14.37)和术后血红蛋白<11g/dL(AOR=5.28,95%CI:1.97,14.18)与手术部位感染显著相关。

结论

妊娠高血压、绒毛膜羊膜炎、中线皮肤切口和术后血红蛋白<11g/dL 是与手术部位感染相关的独立因素。伴有妊娠高血压、绒毛膜羊膜炎和术后贫血的剖宫产术需要特别护理和随访,直至排除手术部位感染。还建议减少广泛的中线皮肤切口,更好地改用 pfannensteil 切口。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ec90/6716814/8c5cd628ba7d/12884_2019_2442_Fig1_HTML.jpg

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