文章摘要
胰十二指肠切除术后手术部位感染的危险因素分析
Analysis of risk factors for surgical site infection after pancreaticoduodenectomy
  
DOI：10.12089/jca.2022.04.011
中文关键词: 胰十二指肠切除术  手术部位感染  危险因素
英文关键词: Pancreaticoduodenectomy  Surgical site infection  Risk factor
基金项目:国家重点研发计划（2018YFC2001900）
作者单位E-mail
缴优优 100853,北京市,解放军总医院第一医学中心麻醉科  
刘艳红 100853,北京市,解放军总医院第一医学中心麻醉科  
贺子乐 100853,北京市,解放军总医院第一医学中心麻醉科  
侯爱生 100853,北京市,解放军总医院第一医学中心麻醉科  
米卫东 100853,北京市,解放军总医院第一医学中心麻醉科  
曹江北 100853,北京市,解放军总医院第一医学中心麻醉科 cjb2000@sina.com 
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中文摘要:
      
目的 分析引起胰十二指肠切除术（PD）后手术部位感染（SSI）的危险因素。
方法 回顾性分析2015年1月至2018年12月择期行PD 1 688例患者的临床资料，男1 047例，女641例，年龄18~87岁，BMI 14~40 kg/m2，ASA Ⅰ—Ⅲ级。记录性别、年龄、BMI、ASA分级、术前合并症、术前检验结果、影像学资料、麻醉时间、手术时间、手术方式、麻醉用药、患者术后去向等。根据术后是否发生SSI将患者分为两组：感染组（n=301）和非感染组（n=1 387）。采用单因素与多因素Logistic回归分析PD术后发生SSI的危险因素。
结果 单因素分析结果显示，感染组BMI、丙氨酸氨基转移酶＞100 U/L的比例、血清白蛋白、白细胞计数及术后进入ICU的比例均明显高于非感染组（P＜0.05），手术时间以及麻醉时间明显长于非感染组（P＜0.05）。多因素Logistic回归分析结果显示，BMI (每增加1 kg/m2，OR=1.075, 95%CI 1.034~1.118，P＜0.001)、术前丙氨酸氨基转移酶水平＞100 U/L (OR=1.317, 95%CI 1.013~1.707, P=0.039)、术前白细胞计数＞10×109/L (OR=1.920, 95%CI 1.160~3.089, P=0.009)及术后进入ICU (OR=2.317, 95%CI 1.796~2.994, P＜0.001)是PD术后SSI发生的独立危险因素。
结论 BMI每增加1 kg/m2、术前白细胞>10×109/L、丙氨酸氨基转移酶水平>100 U/L以及术后进入ICU是胰十二指肠切除术后发生手术部位感染的危险因素。
英文摘要:
      
Objective To analyze risk factors of surgical site infection (SSI) after pancreaticoduodenectomy (PD).
Methods Clinical data of 1 688 patients, 1 047 males and 641 females, aged 18-87 years, BMI 14-40 kg/m2,ASA physical status Ⅰ-Ⅲ. Underwent PD from January 2015 to December 2018 were retrospectively analyzed, including gender, age, BMI, ASA physical status, preoperative complications, preoperative examination data, imaging data, time of anesthesia, operation time,methods of surgery, anesthesia medication, whereabouts of postoperative patients. According to whether they developed SSI after PD, the patients were divided into two groups: infected group (n = 301) and non-infected group (n = 1 387). Risk factors for SSI were analyzed by using univariate analysis and multivariate logistic regression analysis.
Results Univariate analysis showed that BMI, the proportion of alanine aminotransferase > 100 U/L, serum albumin, numeration of leukocyte and the rate of postoperative admission to ICU in infected group were higher than those in the non-infected group (P < 0.05). Meanwhile, the duration of surgery and anesthesia were longer than those in non-infected group (P < 0.05). Multivariate logistic regression analysis showed that the independent risk factors for postoperative infection included BMI (for each 1 kg/m2 increased, OR = 1.075, 95% CI 1.034-1.118, P < 0.001), preoperative alanine aminotransferase level > 100 U/L (OR = 1.317, 95% CI 1.013-1.707, P = 0.039), preoperative leukocyte > 10 × 109/L (OR = 1.920, 95% CI 1.160-3.089, P = 0.009) and postoperative ICU entry (OR = 2.317, 95% CI 1.796-2.994, P < 0.001).
Conclusion Every 1 kg/m2 increase in BMI, preoperative leukocyte > 10 × 109/L, alanine aminotransferase level > 100 U/L and postoperative ICU entry are the risk factors for surgical site infection after pancreaticoduodenectomy.
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