目的 探讨剖宫产术后败血症的危险因素,为临床预防术后败血症提供参考依据.方法 采用回顾性调查方法,选取某妇幼保健院产科2013年1月1日-2016年10月31日剖宫产手术患者,以多因素logistic回归模型进行危险因素分析.结果 共选取剖宫产患者4 604例,发生败血症32例,发病率为0.70％.多因素logistic分析显示,妊娠合并糖尿病(OR=4.03)、有阴道试产(OR=15.86)、阴查次数≥3次(OR=6.77)、胎膜早破≥12 h(OR=3.47)、术中出血量≥1000 mL(OR=4.66)、术后留置导尿管＞24 h(OR=2.83)、一周内有使用抗菌药物史(OR=3.20)共7个指标为剖宫产术后败血症的独立危险因素;孕周≥34 W(OR=0.20)、血红蛋白≥100 g/L(OR=0.40)、清蛋白≥35 g/L(OR=0.28)和正常羊水量(OR=0.22)共4个指标为其保护因素.结论 应针对孕产妇围手术期相关独立危险因素进行严格管理和对保护因素进行医学T预,以期有效预防和控制剖宫产术后败血症的发生.%Objective To explore the risk factors for septicemia after cesarean section,and provide reference for clinical prevention of postoperative septicemia.Methods Clinical data of patients who underwent cesarean section in a maternal and child health hospital between January 1,2013 and October 31,2016 were collected by retrospective survey method,risk factors were analyzed by multivariate logistic regression model.Results A total of 4 604 cases of cesarean section were selected,32 cases of septicemia occurred,incidence was 0.70％.Multivariate logistic regression analysis showed that there were seven independent risk factors for septicemia:gestational diabetes mellitus (OR =4.03),trying vaginal delivery(OR =15.86),No.of vaginal examination ≥3 times(OR =6.77),premature rupture of membrane≥12 hours(OR =3.47),intra-operative bleeding≥1 000 mL(OR =4.66),postoperative duration of indwelling urinary catheter≥24 hours(OR =2.83),and antimicrobial use within a week(OR =3.20).Four factors were protective factors:gestational weeks≥34 weeks(OR =0.20),hemoglobin≥100 g/L(OR =0.40),albumin≥35 g/L(OR-0.28),and amniotic fluid volume at a normal level(OR =0.22).Conclusion It is possible to prevent and control the occurrence of septicemia after cesarean section through strict management of independent risk factors and intervention in protective factors of pregnant women during peri-operative period.
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