开放性骨折患者伤口分泌物的细菌培养及感染原因分析  

Bacterial culture and infection cause of wound secretion in patients with open fracture

作　　者：刘伯让[1] 杨喆[1] 王丹丹[1] 赵俊桃[1] 陈武林[1] 

机构地区：[1]洛阳正骨医院,河南471002

出　　处：《创伤外科杂志》2010年第5期433-436,共4页Journal of Traumatic Surgery

摘　　要：目的为了有效预防和控制开放性骨折感染,笔者采集1 320例开放性骨折患者的伤口分泌物,进行细菌培养,并对其导致感染的原因进行调查、分析。方法 (1)每个患者第1天取2次标本,第1次入院清创前;第2次清创后(或手术后)8小时;(2)在入院后的第2～5天,视患者具体病情再采集标本1～2次;(3)将送检标本接种于血琼脂平板上,有氧条件下37°C培养24小时,经过观察菌落形态、革兰氏染色及生化鉴定,确定细菌种属;(4)收集、分析、记录相关资料(如患者临床资料、实验数据等)。结果 1 320例开放性骨折患者的伤口分泌物标本中,共培养、鉴定出G-菌(占56.6%),G+菌(占43.4%);在需氧条件下培养出细菌生长的标本1 016例,"无细菌生长"的标本304例;刚入院、清创前和清创后8小时两组菌株数样本均数比较,以α=0.05作为检验水准,其P<0.05,差异有显著性;入院清创后8小时留取的标本感染率最低,第3天感染率最高,住院时间的长短与感染率并非正相关;开放性骨折损伤程度越高,感染率越高。结论 G-杆菌成为骨伤科感染的主要致病菌,为预防和控制开放性骨折感染,临床上应对伤口进行厌氧菌培养与其他微生物检测并及时行清创术。Objective To effectively prevent and control the infection of open fracture,1320 wound secretion samples of open fracture were collected to do the bacterial culture and to analyze the cause of infection.Methods（1）Wound secretion samples of every patient were collected before hospital admission or debridement and 8 hours after debridement or operation respectively.（2） Based on every patient＇s condition,samples were collected for 1-2 times during the 2-5 days after hospital admission.（3） After bacterial culture,the bacterial species in every sample was determined.（4） The data were collected and analyzed.Results Totally 1320 samples were collected to do the bacterial culture,1016 samples of them had cultured bacterium.The proportion of Gram-negative bacillus was 56.6%.There was significant difference in the infection rate of samples before hospital admission or debridement and 8 hours after debridement or operation（P0.05）.The infection rate was lowest at 8 hours after debridement and highest on the 3rd day,which had no positive correlation with the length of stay but positively related with the injury degree of open fracture.Conclusion Gram-negative bacillus is the major pathogenic bacterium in the department of fracture and wounds＇ infection.To prevent anaerobic infection,we suggest that we should adopt the measures of anaerobic bacteria culture,microbial detection and debridement.

关 键 词：骨折 分泌物 细菌培养 感染 

分 类 号：R683[医药卫生—骨科学]