肝切除术后手术部位感染的危险因素与预测

潮水

Risk factors and predictors for surgical site infection after hepatic resection
Journal of Hospital Infection
Volume 73, Issue 1, September 2009, Pages 47-53
T. Okabayashia, , , I. Nishimorib, K. Yamashitac, T. Sugimotoa, T. Yatabec, H. Maedaa, M. Kobayashid and K. Hanazakia

Summary
Strict control of blood glucose levels with insulin in a surgical intensive care unit reduces postoperative morbidity and mortality. The aim of this study was to identify risk factors and the predictors for the prevention of surgical site infection (SSI) in a consecutive series of hepatectomised cases in a single institution. The association between SSI and various clinical parameters was investigated in 152 patients who underwent hepatic resection at Kochi Medical School from January 2000 through March 2007. The incidence of SSI in these patients was 14.5%. Multivariate analysis identified four independent parameters correlating with the occurrence of SSI: (i) body mass index >23.6 kg/m2; (ii) estimated blood volume loss >810 mL; (iii) presence of postoperative bile leakage of organ/space SSI; and (iv) use of the sliding scale method for postoperative glucose control. There was no observed SSI after liver resection in the group whose postoperative blood glucose levels were controlled by an artificial pancreas. This study reveals that lack of postoperative glycaemic control is associated with a significantly higher incidence of postoperative infectious complications and longer hospitalisation. Obesity and the level of intraoperative estimated blood loss and bile leakage after hepatic resection are also risk factors with predictive value for SSI. Artificial pancreas is a safe and beneficial device to perform postoperative strict glycaemic control without hypoglycaemia for patients who undergo hepatic resection for liver diseases.

Keywords: Artificial pancreas; Hepatic resection; Hyperglycaemia; STG-22; Surgical site infection

潮水

险因素：体格指数、术中失血量、胆汁漏出和术后血糖控制。人工胰腺有益于肝切除患者.