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中华疝和腹壁外科杂志(电子版)

中华疝和腹壁外科杂志(电子版) ›› 2018, Vol. 12 ›› Issue (04) : 286 -289. doi: 10.3877/cma.j.issn.1674-392X.2018.04.013

所属专题： 文献；

论著

集束式干预措施预防腹股沟疝无张力修补术手术部位感染的随机对照研究
杨春1, 向钱2,†(), 何晓蓉1, 陈岚3, 邓绍平1   
  1. 1. 610072　成都，电子科技大学医学院，四川省医学科学院·四川省人民医院胃肠外科
    2. 610072　成都，电子科技大学医学院，四川省医学科学院·四川省人民医院医院感染管理办公室
    3. 610509　成都市食品药品检验研究院
  • 收稿日期:2018-05-09 出版日期:2018-08-18
  • 通信作者: 向钱

Randomized Controlled Trial on Preventing of Surgical Site Infection of Tension-free Repair of Inguinal Hernias with A Bundled Intervention

Chun Yang1, Qian Xiang2,†(), Xiaorong He1, Lan Chen3, Shaoping Deng1   

  1. 1. School of Medicine, University of Electronic Science and Technology of China; Department of Gastrointestinal Surgery, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu 610072, Sichuan, China
    2. Infection Control Department, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu 610072, Sichuan, China
    3. Chengdu Institute of Food and Drug Inspection, Chengdu 610509, Sichuan, China
  • Received:2018-05-09 Published:2018-08-18
  • Corresponding author: Qian Xiang
  • About author:
    Corresponding author:Xiang Qian, Email:
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杨春, 向钱, 何晓蓉, 陈岚, 邓绍平. 集束式干预措施预防腹股沟疝无张力修补术手术部位感染的随机对照研究[J]. 中华疝和腹壁外科杂志(电子版), 2018, 12(04): 286-289.

Chun Yang, Qian Xiang, Xiaorong He, Lan Chen, Shaoping Deng. Randomized Controlled Trial on Preventing of Surgical Site Infection of Tension-free Repair of Inguinal Hernias with A Bundled Intervention[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2018, 12(04): 286-289.

目的

探索集束式干预措施对于预防腹股沟疝修补术手术部位感染的效果。

方法

收集2016年12月至2017年10月，四川省人民医院125例腹股沟疝修补术手术患者，其中117例（93.6%）完成研究。采用随机对照试验，将腹股沟疝修补术患者按照随机数字表法分为干预组和对照组。干预组54例，实施集束式干预措施（术前洗必泰沐浴、电动备皮器备皮、手术当天备皮、使用洗必泰醇复方成分的皮肤消毒剂）；对照组63例，采用常规措施。按照美国NHSN 2013年手术部位感染监测定义和监测方法，观察和比较2组患者的手术部位感染发生率和医疗成本消耗情况。

结果

干预组腹股沟疝修补术手术部位感染发生率3.70%（2/54），对照组12.70%（8/63），2组比较，差异无统计学意义（χ2=1.969，P=0.161）；干预组平均住院时间7（4～32）d，对照组8（3～45）d，2组比较，差异有统计学意义（Z=－1.995，P=0.046）；干预组平均治疗总费用10 655.00（7 295.51～28 917.02）元，对照组11 737.96（7 953.61～24 103.04）元，2组比较，差异有统计学意义（Z=－2.433，P=0.015）。

结论

暂未观察到集束式干预措施可显著降低腹股沟疝修补术手术部位感染的发生率，其有效性有待进一步研究确认；但集束式干预措施可有效缩短腹股沟疝修补术患者平均住院时间和平均治疗费用，从而提高医疗资源利用率、医院的收入，降低医疗费用支出。

关键词: 疝，腹股沟, 疝修补术, 手术部位感染, 集束式干预措施
Objective

To explore a bundled intervention (preoperative chlorhexidine bath, electric skin preparation, skin preparation on the day of surgery, skin disinfectant with chlorhexidine compound) for prevention surgical site infection (SSI) of inguinal hernia repair.

Methods

From December 2016 to October 2017, 125 patients with inguinal hernia in Sichuan Provincial People's Hospital were enrolled. Of these, 117 (93.6%) completed the study. Patients with inguinal hernia repair were divided into intervention group and control group according to random number table method. 54 patients in the intervention group were treated with the bundled intervention; 63 patients in the control group were treated with conventional measures. The incidence of SSI and the medical cost of the two groups were observed and compared.

Results

The incidence of SSI was 3.70% (2/54) in the intervention group and 12.70% (8/63) in the control group. There was no significant difference between the two groups (χ2=1.969, P=0.161). The average hospital stay was 7 days (4 to 32 days) in the intervention group, and the control group was 8 days (3 to 45 days). The difference between the two groups was statistically significant (Z=-1.995, P=0.046). The average treatment cost of the intervention group was 10 655 yuan (7 295.51 to 28 917.02) yuan, the control group was 11 737.96 yuan (7 953.61 to 24 103.04) yuan, and the difference between the two groups was statistically significant (Z=-2.433, P=0.015).

Conclusion

The bundled intervention has not been observed to significantly reduce the incidence of SSI in inguinal hernia repair, and its effectiveness needs further study. However, the bundled intervention can effectively shorten the average length of hospital stay and average treatment cost for patients with inguinal hernia.

Key words: Hernia, groin, Herniorrhaphy, Surgical site infection, Bundled intervention
表1 2组患者的一般情况比较
组别 例数 性别(例) 年龄(岁) 患者ASA分级(例) 手术NISS分级(例)
男 女 1 2 3 0 1 2
干预组 54例 47 7 62(19~78) 19 31 4 42 11 1
对照组 63例 55 8 62(20~84) 19 44 0 42 21 0
统计值 ? χ2=0.002 Z=-0.118 Z=-0.000 Z=-1.041
P值 ? 0.966 0.906 0.987 0.308
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