国际妇产科学杂志 ›› 2019, Vol. 46 ›› Issue (2): 233-237.

• 论著 • 上一篇    下一篇

妇产科围手术期脓毒症的临床分析

佟彤,高红   

  1. 100026 首都医科大学附属北京妇产医院
  • 收稿日期:2018-09-17 修回日期:2019-02-01 出版日期:2019-04-15 发布日期:2019-04-15

Clinical Analysis of Perioperative Sepsis in Obstetrics and Gynecology

TONG Tong, GAO Hong   

  1. Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China
  • Received:2018-09-17 Revised:2019-02-01 Published:2019-04-15 Online:2019-04-15

摘要: 目的:分析妇产科围手术期脓毒症的病例特点,为脓毒症的防治提供依据。方法:收集首都医科大学附属北京妇产医院2011年1月—2017年12月诊断为脓毒症的病例14例,分析其病例特点,并根据病原学分为G-杆菌组及G+球菌组(真菌感染患者仅有1例,未作统计学分析),对比组间差异。结果:妇产科围手术期脓毒症的病原体多为G-杆菌,占71.4%,脓毒症患者血白细胞计数、C反应蛋白水平、降钙素原水平均较正常参考值显著升高,G-杆菌组纤维蛋白原(FIB)较G+球菌组显著减低(P=0.045),G-杆菌组国际标准化比值(INR)(P=0.043)及D-二聚体(D-D)(P=0.039)较G+球菌组显著升高,差异均有统计学意义。5例脓毒性休克患者均为G-杆菌感染。结论:妇产科围手术期脓毒症以G-杆菌感染为主,炎症反应强烈,同时伴随严重的凝血功能异常,易发生脓毒性休克,及早发现、经验性抗感染治疗及早期应用低分子肝素预防弥散性血管内凝血(DIC)对改善预后至关重要。

关键词: 妇产科, 医院, 妇科外科手术, 手术期间, 脓毒症, 毒血症, 革兰氏阴性菌, 炎症

Abstract: Objective:To analyze the characteristics of perioperative sepsis in obstetrics and gynecology, and to provide evidence for the prevention and treatment of sepsis. Methods: The cases of sepsis diagnosed in Beijing Obstetrics and Gynecology Hospital from January 2011 to December 2017 were collected. The characteristics of the cases were analyzed. According to the pathogens, the differences between the G- bacteria group and the G+ cocci group were compared. Results: The pathogens of perioperative sepsis in gynecology and obstetrics were mostly G- bacteria, accounting for 71.4%. The white blood cell count, C-reactive protein level and procalcitonin level were significantly increased in patients with sepsis. The fibrinogen (FIB) of the G- bacteria group was significantly lower than that of the G+ cocci group (P=0.045). The international normalized ratio (INR) of the G-bacteria group (P=0.043) and the D-dimer (DD) (P=0.039) was significantly higher than the G+ cocci group. The differences were statistically significant. 5 patients with septic shock were all G- bacteria infection. Conclusions: Perioperative sepsis in obstetrics and gynecology is mainly caused by G- bacteria infection.This type of sepsis has a strong inflammatory response, severe coagulopathy, and septic shock tendency. Early detection, empirical anti-infective therapy, and early application of low molecular weight heparin to prevent disseminated intravascular coagulation (DIC) are critical for improving prognosis.

Key words: Obstetrics and gynecology department, hospital, Gynecologic surgical procedures, Intraoperative period, Sepsis, Toxemia, Gram-negative bacteria, Inflammation