开放性骨折患者创口感染临床分析与预防对策  

Clinical analysis of wound infections in open fracture patients and prevention countermeasures

作　　者：许敏[1] 石焱[2] 任晓明[2] 杭灵燕[1] 沈佳俐[1] 

机构地区：[1]杭州市第一人民医院七东骨科,浙江杭州310006 [2]杭州市第一人民医院针炙推拿科,浙江杭州310006

出　　处：《中华医院感染学杂志》2015年第14期3286-3288,共3页Chinese Journal of Nosocomiology

基　　金：浙江省中医药管理局基金资助项目(2014zA085)

摘　　要：目的探讨开放性骨折患者创口感染及其病原菌分布,为临床防治创口感染提供参考依据。方法选择医院骨科2012年1月-2014年12月收治的1 206例开放性骨折患者为研究对象,调查分析患者创口感染率及其病原菌分布,病原菌采用法国生物梅里埃公司生产的全自动微生物分析仪进行鉴定,数据统计采用Microsoft Office Excel 2007进行录入分析。结果共166例发生创口感染,感染率为13.8%;不同Gustilo分型骨折患者Ⅰ型感染率为2.1%、Ⅱ型感染率为12.9%、Ⅲ型感染率为18.4%,创口感染率比较,差异有统计学意义(χ2=26.258,P<0.01);上肢骨折感染率为9.4%、下肢骨折感染率为17.3%、颈肩骨折感染率为10.9%、腰髋骨折感染率为13.4%,不同骨折部位患者创口感染率比较,差异有统计学意义(χ2=10.222,P<0.05);共分离鉴定出病原菌125株,其中革兰阳性菌50株占40.0%,革兰阴性菌69株占55.2%,真菌6株占4.8%。结论开放性骨折患者创口感染发生率较高,创口感染与骨折Gustilo分型和骨折部位明显相关,其感染病原菌以革兰阴性菌为主。OBJECTIVE To explore the incidence of wound infections in the patients with open fracture and analyze the distribution of pathogens so as to provide guidance for clinical prevention of wound infections.METHODS A total of 1 206 patients with open fractures who were treated in the department of orthopedics from Jan 2012 to Dec2014were recruited as the study objects,then the incidence of wound infections and distribution of pathogens were investigated,the pathogens were identified by using automatic microorganism analyzer,and the statistical analysis was performed with the use of Microsoft Office Excel 2007.RESULTS The wound infections occurred in 166 patients,with the infection rate of 13.8%.According to the Gustilo typing,the infection rate was 2.1%in the typeⅠ fracture patients,12.9%in the typeⅡ fracture patients,and 18.4%in the typeⅢ facture patients,with significance（χ2=26.258,P〈0.01）.The infection rate was 9.4%in the patients with upper limb fracture,17.3%in the patients with lower limb fracture,10.9%in the patients with neck fracture,and 13.4%in the patients with waist and hip fracture,there was significant difference in the incidence of wound infections among the patients with different sites of fractures（χ2=10.222,P〈0.05）.Totally 125 strains of pathogens have been isolated,including 50（40.0%）strains of gram-positive bacteria,69（55.2%）strains of gram-negative bacteria,and 6（4.8%）strains of fungi.CONCLUSIONThe incidence of wound infections is high in the patients with open fractures.The wound infections are significantly associated with the Gustilo typing and the fracture sites,and the gram-negative bacteria are dominant among the pathogens causing the infections.

关 键 词：开放性骨折 创口感染 病原菌 预防对策 

分 类 号：R619.3[医药卫生—外科学]