四肢骨折内固定术后手术部位感染危险因素  

Risk factors of surgical site infection in patients with internal fixation surgery for limb fracture

作　　者：白博[1,2] 桑宏勋[3] 吴子祥[1] 郇科 苏菲[1] 刘斌[1] 

机构地区：[1]第四军医大学西京医院,陕西西安710032 [2]空军临潼航空医学鉴定训练中心,陕西西安710600 [3]南方医科大学深圳医院,广东深圳518000

出　　处：《中国感染控制杂志》2017年第4期334-337,共4页Chinese Journal of Infection Control

基　　金：国家自然科学基金资助项目(81270959)

摘　　要：目的了解四肢骨折患者内固定术后手术部位感染(SSI)的发病率和危险因素。方法收集某院2013年1月—2016年1月收治的四肢骨折接受内固定手术治疗的患者资料,将术后发生SSI的39例患者纳入感染组,按1∶2的比例随机抽取同期术后未发生SSI的78例患者作为对照组,分析SSI的危险因素。结果 4 125例骨折内固定患者术后SSI发生率为0.95%(39例),感染组细菌培养阳性率为87.2%(34/39),共分离病原菌38株,其中革兰阳性菌22株(57.9%),革兰阴性菌15株(39.5%),真菌1株(2.6%),金黄色葡萄球菌是主要致病菌(47.4%),多重耐药菌20株。单因素分析结果显示,合并基础疾病、受伤至手术时间≥8 h、开放性骨折、多处骨折、手术时间≥180 min、术中失血量≥400 mL、术中输入异体血、术后引流管留置时间≥5 d、平均住院时间≥14 d,感染组与对照组比较,差异有统计学意义(均P<0.05)。多因素logistic回归分析结果显示,受伤至手术时间≥8 h、开放性骨折、手术时间≥180 min、术后引流管留置时间≥5 d、住院时间≥14 d是骨折内固定术后SSI的危险因素(均P<0.05)。结论四肢骨折内固定术后患者发生SSI的危险因素较多,减少危险因素,对降低SSI发生率,提高治愈率有积极作用。Objective To investigate the incidence and risk factors of surgical site infection（SSI） in patients with internal fixation surgery for limb fracture.Methods Medical data of patients with internal fixation surgery for limb fracture in a hospital from January 2013 to January 2016 were collected, 39 patients with SSI following internal fixation was as infection group, according to the 1：2 ratio, 78 patients without SSI following operation during the same period were randomly selected as the control group, risk factors of SSI were analyzed.Results Among 4 125 patients undergoing internal fixation surgery, incidence of SSI was 0.95% （n=39）, the positive rate of bacterial culture in infection group was 87.2% （34/39）, a total of 38 strains of pathogenic bacteria were isolated, among which 22 were gram-positive strains （57.9%）, 15（39.5%）were gram-negative strains,1（2.6%） was fungi,Staphylococcus aureus was the main pathogenic bacteria （47.4%）, and there were 20 isolates of multidrug-resistant organisms.Univariate analysis showed that infection group and control group was significantly different in the following aspects： combined underlying diseases, time from injury to operation≥8 hours, open fracture, multiple fracture, duration of operation≥180 minutes, intra-operative blood loss≥400 mL, allogeneic blood transfusion, duration of postoperative indwelling drainage tube≥5 days, and average length of hospital stay≥14 days （all P〈0.05）.Multivariate logistic regression analysis showed that the following factors were risk factors for SSI following internal fixation surgery for fracture： time from injury to operation≥8 hours, open fracture, duration of operation≥180 minutes, duration of postoperative indwelling drainage tube≥5 days, and average length of hospital stay≥14 days （all P〈0.05）.Conclusion Risk factors for SSI in patients with internal fixation surgery for limb fracture are multiple, reducing risk factors has a positive effect on decreasing the incidence

关 键 词：骨折 内固定术 手术部位感染 术后感染 危险因素 

分 类 号：R181.32[医药卫生—流行病学] R687.3[医药卫生—公共卫生与预防医学]