不同术前皮肤准备方案与手术切口感染的关系研究

目的:研究不同术前皮肤准备方案与手术切口感染(SSI)的关系,为降低临床SSI发生率提供参考。方法:选择自2015年1月～2019年12月在医院行手术治疗的患者1810例为本次研究对象。根据析因设计表,将因素A:是否剃毛(1不剃毛;2剃毛),B:清洁方式(1清水清洁;2肥皂水清洁),C:术前备皮时间(1术前1 d;2术前2 h)配对分为8个组:A1B1C1组226例,A1B2C1组229例,A1B1C2组216例,A1B2C2组232例,A2B1C1组221例,A2B2C1组241例,A2B1C2组221例,A2B2C2组224例,比较各组手术部位及切口类型分布、术后SSI发生率,并采用析因分析法分析术前皮肤准备后各组菌落计数的相关性及交互作用。结果:各组患者的手术部位及切口类型之间的差异不存在统计学意义(P0.05)。A1B1C1组及A2B1C1组的SSI发生率较高,分别为12.83%和14.48%。A1水平的SSI发生率是8.75%,与A2水平的8.27%相比,差异不存在统计学意义(P0.05)。B1、C1水平的SSI发生率分别是11.31%、10.03%,明显高于B2、C2水平的5.83%、6.94%,差异均存在统计学意义(P0.05)。各组术前皮肤准备后的菌落计数差异存在统计学意义(P0.05),析因分析结果显示,B、C单因素分析差异存在统计学意义(P0.05),且A与C,B与C间具有交互作用,而A、B、C间具有二级交互作用(P0.05)。结论:术前皮肤准备对降低SSI发生具有重要作用,实际操作时,建议在较短的时间内利用肥皂水或其他消毒水进行皮肤清洗并完成备皮。

Study on the Relationship between Different Preoperative Skin Preparation Schemes and Incision Infection

ABSTRACT Objective: To study the relationship between different preoperative skin preparation schemes and surgical site infection(SSI)so as to provide the reference for reducing the clinical incidence rate of SSI. Methods: A total of 1810 patients who were received surgery in hospital from January 2015 to December 2019 were selected as the study subjects. According to the factorial design table, the three factors of factor A: whether shaving(1 without shaving; 2 shaving), factor B:cleaning methods(1 water cleaning; 2 soap water cleaning), factor C: preoperative skin preparation time(1 1d before surgery; 2 2h before surgery) were divided into 8 pairing groups, they were A1B1C1 group with 226 patients, A1B2C1 group with 229 patients, A1B1C2 group with 216 patients, A1B2C2 group with 232 patients, A2B1C1 group with 221 patients, A2B2C1 group with 241 patients, A2B1C2 group with 221 patients, A2B2C2 group with 224 patients, the distribution of surgical sites and incision types and the incidence rate of SSI in different groups were compared, and the correlation and interaction of colony counting among different groups analyzed by factorial analysis after preoperative skin preparation. Results: The differences of the surgical sites and incision types in different groups had no statistical significant(P>0.05). The incidence rates of SSI were higher in A1B1C1 group and A2B1C1 group, the incidence rates were 12.83% and 14.48% respectively. The incidence rates of SSI at level A1 was 8.75%, which had no statistical difference than 8.27% at level A2(P>0.05). The incidence rates of SSI at B1, C1 levels were 11.31%, 10.03% respectively, which were significantly higher than 5.83%, 6.94% at B2, C2 levels, the differences were statistically significant(P<0.05). The difference of colony counting among different groups after preoperative skin preparation had statistical significant(P<0.05), and the factorial analysis showed the difference of single factors of B, C had statistical significant(P<0.05), and there were interaction between A and C, B and C, furthermore, there was second-level interaction among A, B, C(P<0.05). Conclusion: Preoperative skin preparation plays an important role in reducing the incidence rate of SSI, in actual practice, it is suggest to using soap water or other disinfection to clean the skin and complete skin preparation in a relatively short period of time.