GustiloⅢ型开放性骨折术后医院感染危险因素及负压封闭引流技术的疗效评价  

Risk factors of nosocomial infections after Gustilo type Ⅲ open fracture operation and effect of negative pressure closed drainage technique

作　　者：贾丙申[1] 于鹏[1] 周立义[1] 李君 纪志华[1] 

机构地区：[1]海南医学院第一附属医院关节创伤外科,海南海口570102

出　　处：《中华医院感染学杂志》2017年第19期4488-4491,共4页Chinese Journal of Nosocomiology

摘　　要：目的分析GustiloⅢ型开放性骨折术后院内感染的危险因素,并探究负压封闭引流技术对该术后的治疗效果。方法选择2013年1月-2016年6月在医院治疗的1020例GustiloⅢ型开放性骨折术后患者,回顾分析临床资料,对术后医院感染的危险因素进行分析。另选择同期1020例GustiloⅢ型开放性骨折术后患者,根据治疗方式分为实验组583例、对照组437例,实验组采用负压封闭引流治疗,对照组采用常规换药治疗,比较两组创面愈合时间、骨折愈合时间、住院时间及术后3月内创面细菌转阴率及愈合率。结果 1020例患者院内感染20例,感染率为1.96%;多因素logistic结果显示:年龄>60岁、损伤程度为ⅢB或ⅢC、治疗间隔>6h、手术时长>2.5h、住院时间>10d、术前使用抗菌药物或激素、术中采用全身麻醉方式及术后未使用负压封闭引流等是院内感染的危险因素;实验组创面愈合时间、骨折愈合时间及住院时间分别为(10.93±10.88)d、(211.32±18.03)d和(15.96±2.43)d均短于对照组(19.07±1.69)d、(263.42±20.49)d和(24.01±3.11)d,差异有统计学意义(P<0.05),术后3月内细菌转阴率及创面愈合率均显著高于对照组(P<0.05)。结论负压封闭引流术具有缩短愈合时间、加速创口愈合、降低医院感染率等特点,治疗效果优良。OBJECTIVE To analyze the risk factors of nosocomial infections after Gustilo typeⅢ open fracture operation and explore the effect of negative pressure closed drainage.METHODS A total of 1020 cases of Gustilo typeⅢ open fracture patients from Jan.2013 to Jun.2016 were selected.The clinical data were retrospectively analyzed,and the risk factors of postoperative nosocomial infections were analyzed.Another 1020 cases of Gustilo typeⅢ open fracture patients were selected at the same period,and were divided into experimental group（n=583）and control group（n=437）according to treatment method.The experimental group was treated with negative pressure closed drainage,while the control group was treated with conventional dressing.The wound healing time,fracture healing time,length of hospital stay and the wound bacterial turnover rate and healing rate within 3months after operation between the two groups were compared.RESULTS There were 20 cases of nosocomial infections in 1020 cases of patients,and the infection rate was 1.96%.The results of multivariate logistic analysis showed that age〉60years old,ⅢB orⅢC injury,treatment interval〉6h,duration of operation〉2.5h,length of hospitalization10d,using antibiotics or hormones,using general anesthesia during the operation and without negative pressure closed drainage after operation were the risk factors for nosocomial infections.The wound healing time,fracture healing time and hospitalization time of experimental group were（10.93±10.88）d,（211.32±18.03）d and（15.96±2.43）d,which were significantly shorter than（19.07±1.69）d,（263.42±20.49）d and（24.01±3.11）d of control group（P〈0.05）.The bacterial turnover rate and wound healing rate at 3months after operation of experimental group were significantly higher than those of control group（P〈0.05）.CONCLUSION Negative pressure closed drainage can shorten healing time,accelerate wound healing and reduce nosocomial infection rate,and the treatment effect is good.

关 键 词：GustiloⅢ型开放性骨折 院内感染 危险因素 负压封闭引流 

分 类 号：R687.3[医药卫生—骨科学]