应用改良累积疾病评分量表预测剖宫产术后感染性并发症的可能性评估研究

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论证。在产科，没有任何系统或量表可用于评估躯体负担，预测和选择产后（术后）化脓性炎症并发症的经验性抗生素治疗。

该研究的目的是评估为产科病人修改的累积疾病评分表的有效性，该评分表称为CIRS-Obs。作者在其中纳入了剖腹产后抗生素耐药感染性并发症的高度信息预测因素。

材料与方法。2008年9月至2020年9月期间，对The Mariinsky Hospital妇科收治的406例剖腹产后被诊断为子宫内膜炎的产科患者的病历进行了回顾性研究。一项多变量回归分析确定了对子宫内膜炎的不利病程和有身体疾病史的女性患者分离出的多抗性病原体具有高预测价值的指标，并将其纳入CIRS-Obs。

结果。与子宫内膜炎患者出现耐药性和多重耐药性病原体的高风险相关的最重要的预测因素包括：CIRS评分≥4分；紧急剖腹产合并分娩时间延长和无水间隔；在怀孕的第三个月使用抗生素；怀孕期间住院；侵入性治疗或手术。

结论。作者开发了一个评估剖腹产后子宫内膜炎妇女耐药性和多重耐药性病原体风险的量表，根据患者的体质状况、抗生素摄入量和手术条件，提高了做出合理治疗决定的预后的可靠性。

作者简介

Nikolay A. Korobkov

North-Western State Medical University nаmed after I.I. Mechnikov; Kirov Military Medical Academy

Email: nikolai_korobkov@mail.ru
ORCID iD: 0000-0001-7279-2535
SPIN 代码: 4191-3581

MD, Cand. Sci. (Med.)

俄罗斯联邦, 41 Kirochnaya St., Saint Petersburg, 191015; Saint Petersburg

Natalya V. Bakulina

North-Western State Medical University nаmed after I.I. Mechnikov

Email: nv_bakulina@mail.ru
ORCID iD: 0000-0003-4075-4096
SPIN 代码: 9503-8950

MD, Dr. Sci. (Med.)

俄罗斯联邦, 41 Kirochnaya St., Saint Petersburg, 191015

Margarita A. Repina

North-Western State Medical University nаmed after I.I. Mechnikov

编辑信件的主要联系方式.
Email: marepina@inbox.ru
Scopus 作者 ID: 496280

MD, Dr. Sci. (Med.), Professor, Honoured Science Worker

俄罗斯联邦, 41 Kirochnaya St., Saint Petersburg, 191015

参考

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  11. Prikaz Minzdrava Rossii ot 01.11.2012 No. 572n “Ob utverzhdenii poryadka okazaniya meditsinskoy pomoshchi po profilyu “akusherstvo i ginekologiya (za isklyucheniyem ispol’zovaniya VRT)” [Internet]. Spravochnaya pravovaya sistema “Konsul’tantPlyus”. Available from: http://www.consultant.ru. Accessed: Sep 15, 2021. (In Russ.)

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2. 图 1 根据累积的疾病评级表，不同器官系统在病理过程中的参与情况 Fig. 1. Structure and frequency of involved systems in postpartum women with endometritis after caesarean section according to the cumulative disease rating scale

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3. 图 2 根据累积疾病评定量表（CIRS）的级别，按照从塬来分离的耐药性和多耐药性病原体的比例对患者进行分布 Fig. 2. Distribution of the patients by the levels of the cumulative illness rating scale (CIRS) according to the proportion of resistant and multidrug-resistant pathogens isolated from lochia

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4. 图 3 抗生素耐药性病原体表型与CIRS-Obs之比：0-1为第一组（无抗生素耐药性感染风险）；2-3为第二组（标准风险），≥4为第三组（高风险） Fig. 3. The ratio of antibiotic-resistant phenotypes causative agents of endometritis and CIRS-Obs indices: 0–1 points — 1st group (no risk of developing an infection resistant to antibiotics); 2-3 points — group 2 (standard risk) and ≥4 points — group 3 (high risk)

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5. 图 4 累积疾病评定量表（CIRS-Obs）变体的ROC曲线 Fig. 4. ROC-curve of modification of the Cumulative Illness Rating Scale (CIRS-Obs)

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6. 图 5 累积疾病评定量表（CIRS）的ROC曲线 Fig. 5. ROC-curve of the Cumulative Illness Rating Scale (CIRS)

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