抗菌薇喬縫線預防胃腸急診手術切口感染的臨床研究_《中國普外基礎與臨床雜志》

作者：

文坤明 , 曾慶良 , 馮國麗 , 黃韓冬

遵義醫學院附屬醫院胃腸外科(貴州遵義563003);

關鍵詞：

抗菌薇喬縫線胃腸急診手術切口感染

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目的評價抗菌薇喬縫線在預防胃腸急診手術切口感染中的作用。方法前瞻性地在遵義醫學院附屬醫院胃腸外科2009年5月至2010年8月期間共實施的412例胃腸急診手術患者中隨機選擇198例患者在關腹時采用抗菌薇喬縫線(抗菌薇喬縫線組)，其余214例患者采用傳統絲線縫合(傳統絲線組)。分析2組患者可能影響切口愈合的因素及比較2組切口感染發生率。結果2組患者的性別、年齡、體重指數、合并糖尿病、HIV感染、近期內使用免疫抑制劑、糖皮質激素或類固醇、手術切口類型、術中出血量及手術時間方面的比較差異均無統計學意義(P gt;0.05)，具有可比性。切口感染率在抗菌薇喬縫線組〔3.0%(6/198）〕明顯低于傳統絲線組〔11.7%(25/214)〕，P lt;0.001。2組患者按手術切口分組: Ⅲ類切口感染率在抗菌薇喬縫線組〔3.5%(5/141)〕明顯低于傳統絲線組〔14.3%(22/154)〕，P lt;0.001。2組患者按手術時間分組: 手術時間≥120 min時的切口感染率在抗菌薇喬縫線組〔3.3%(2/60)〕明顯低于傳統絲線組〔21.2%(11/52)〕，P=0.008。結論抗菌薇喬縫線較普通絲線縫線有助于降低Ⅲ類切口及手術時間≥120 min的胃腸急診手術的切口感染率。

引用本文： 文坤明,曾慶良,馮國麗,黃韓冬. 抗菌薇喬縫線預防胃腸急診手術切口感染的臨床研究. 中國普外基礎與臨床雜志, 2011, 18(9): 969-972. doi: 復制

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16.	雷澤華, 張道寶, 俞慎林. 外科手術切口感染的危險因素分析及其預防 [J]. 現代預防醫學, 2010, 37(4): 789791.
17.	肖漢強, 黃秀良. 外科手術切口感染監測分析與控制 [J]. 中華醫院感染學雜志, 2010, 20(2): 204206.
18.	覃忠衛. 普通外科手術切口感染相關因素Logistic回歸分析 [J]. 中華醫院感染學雜志, 2009, 19(23): 32003201.
19.	郭志晨, 葉竹梅, 黃樟生, 等. 外科腹部手術后切口感染的危險因素 [J]. 中華醫院感染學雜志, 2006, 16(7): 761762.
20.	Franchi M, Ghezzi F, BenedettiPanici PL, et al. A multicentre collaborative study on the use of cold scalpel and electrocautery for midline abdominal incision [J]. Am J Surg, 2001, 181(2): 128132.
21.	Israelsson LA, Jonsson T, Knutsson A. Suture technique and wound healing in midline laparotomy incisions [J]. Eur J Surg, 1996, 162(8): 605609.
22.	張林, 曹永寬, 張國虎, 等. 腹膜外放置U型乳膠引流條在控制胃腸手術切口感染中的應用研究 [J]. 中國普外基礎與臨床雜志, 2009, 16(11): 925927.
23.	王紅梅, 張梅. 普通外科手術切口感染調查與分析 [J] . 中國感染控制雜志, 2007, 6(1): 3334.
24.	丁杰, 張忠民, 潘揚, 等. 普通外科切口感染危險因素分析 [J]. 中華醫院感染學雜志, 2009, 19(16): 21062108.

1. Engemann JJ, Carmeli Y, Cosgrove SE, et al. Adverse clinical and economic outcomes attributable to methicillin resistance among patients with Staphylococcus aureus surgical site infection [J]. Clin Infect Dis, 2003, 36(5): 592598.
2. Zhan C, Miller MR. Excess length of stay, charges, and mortality attributable to medical injuries during hospitalization [J]. JAMA, 2003, 290(14): 18681874.
3. Dimick JB, Chen SL, Taheri PA, et al. Hospital costs associated with surgical complications: a report from the privatesector National Surgical Quality Improvement Program [J]. J Am Coll Surg, 2004, 199(4): 531537.
4. Justinger C, Moussavian MR, Schlueter C, et al. Antibacterial [corrected] coating of abdominal closure sutures and wound infection [J]. Surgery, 2009, 145(3): 330334.
5. GómezAlonso A, GarcíaCriado FJ, ParreoManchado FC, et al. Study of the efficacy of Coated VICRYL Plus Antibacterial suture (coated Polyglactin 910 suture with Triclosan) in two animal models of general surgery [J]. J Infect, 2007, 54(1): 8288.
6. 李景春, 宋立偉, 王彩平. 預防穿孔性闌尾炎切口感染的兩點改進 [J]. 中國普外基礎與臨床雜志, 2008, 15(1): 26.
7. Edmiston CE, Seabrook GR, Goheen MP, et al. Bacterial adherence to surgical sutures: can antibacterialcoated sutures reduce the risk of microbial contamination? [J]. J Am Coll Surg, 2006, 203(4): 481489.
8. Jones RD, Jampani HB, Newman JL, et al. Triclosan: a review of effectiveness and safety in health care settings [J]. Am J Infect Control, 2000, 28(2): 184196.
9. Fiss EM, Rule KL, Vikesland PJ. Formation of chloroform and other chlorinated byproducts by chlorination of triclosancontaining antibacterial products [J]. Environ Sci Technol, 2007, 41(7): 23872394.
10. Barbolt TA. Chemistry and safety of triclosan, and its use as an antimicrobial coating on Coated VICRYL* Plus Antibacterial Suture (coated polyglactin 910 suture with triclosan) [J]. Surg Infect (Larchmt), 2002, 3 Suppl 1: S45S53.
11. Rothenburger S, Spangler D, Bhende S, et al. In vitro antimicrobial evaluation of Coated VICRYL* Plus Antibacterial Suture (coated polyglactin 910 with triclosan) using zone of inhibition assays [J]. Surg Infect (Larchmt), 2002, 3 Suppl 1: S79S87.
12. Ford HR, Jones P, Gaines B, et al. Intraoperative handling and wound healing: controlled clinical trial comparing coated VICRYL plus antibacterial suture (coated polyglactin 910 suture with triclosan) with coated VICRYL suture (coated polyglactin 910 suture) [J]. Surg Infect (Larchmt), 2005, 6(3): 313321.
13. Storch ML, Rothenburger SJ, Jacinto G. Experimental efficacy study of coated VICRYL plus antibacterial suture in guinea pigs challenged with Staphylococcus aureus [J]. Surg Infect (Larchmt), 2004, 5(3): 281288.
14. 中華人民共和國衛生部. 醫院感染診斷標準 [M]. 北京: 中華人民共和國衛生部, 2001: 1012.
15. 王秀茹. 預防醫學微生物學及檢驗技術 [M]. 北京: 人民衛生出版社, 2002: 11371138.
16. 雷澤華, 張道寶, 俞慎林. 外科手術切口感染的危險因素分析及其預防 [J]. 現代預防醫學, 2010, 37(4): 789791.
17. 肖漢強, 黃秀良. 外科手術切口感染監測分析與控制 [J]. 中華醫院感染學雜志, 2010, 20(2): 204206.
18. 覃忠衛. 普通外科手術切口感染相關因素Logistic回歸分析 [J]. 中華醫院感染學雜志, 2009, 19(23): 32003201.
19. 郭志晨, 葉竹梅, 黃樟生, 等. 外科腹部手術后切口感染的危險因素 [J]. 中華醫院感染學雜志, 2006, 16(7): 761762.
20. Franchi M, Ghezzi F, BenedettiPanici PL, et al. A multicentre collaborative study on the use of cold scalpel and electrocautery for midline abdominal incision [J]. Am J Surg, 2001, 181(2): 128132.
21. Israelsson LA, Jonsson T, Knutsson A. Suture technique and wound healing in midline laparotomy incisions [J]. Eur J Surg, 1996, 162(8): 605609.
22. 張林, 曹永寬, 張國虎, 等. 腹膜外放置U型乳膠引流條在控制胃腸手術切口感染中的應用研究 [J]. 中國普外基礎與臨床雜志, 2009, 16(11): 925927.
23. 王紅梅, 張梅. 普通外科手術切口感染調查與分析 [J] . 中國感染控制雜志, 2007, 6(1): 3334.
24. 丁杰, 張忠民, 潘揚, 等. 普通外科切口感染危險因素分析 [J]. 中華醫院感染學雜志, 2009, 19(16): 21062108.

《中國普外基礎與臨床雜志》

抗菌薇喬縫線預防胃腸急診手術切口感染的臨床研究

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