烧伤整形术后患者发生感染相关危险因素及诊疗对策  

Risk factors, diagnosis and treatment of postoperative infection in patients with burn plastic surgery

作　　者：卜伟冥 廖钰珊[2] 苏日跃 韦昌延[1] 

机构地区：[1]钦州市第一人民医院外四科,钦州市535000 [2]钦州市第一人民医院感染科,钦州市535000

出　　处：《中华实验和临床感染病杂志（电子版）》2017年第6期595-598,共4页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

摘　　要：目的探究烧伤患者实施整形术后易引发感染的相关因素,并提出相应的诊疗对策和建议。方法采用随机抽样的方法选取本院2013年1月至2015年12月收治的术后出现感染的患者共88例(感染组),同时选取该时间段内术后未发生感染的88例烧伤患者为对照组。采用单因素分析和多因素Logistic回归分析来探讨烧伤整形术后感染的影响因素与诊疗对策。结果单因素分析结果显示,术区有无瘢痕褶皱、有无残余创面、抗菌药物使用种类和手术时间等因素均与烧伤整形术后感染相关;根据多因素Logistic回归分析结果,同时使用两种及以上抗菌药物(OR=2.812、P=0.026)、术区有瘢痕褶皱(OR=3.148、P=0.011)、术区有残余创面(OR=2.711、P=0.030)和手术时间≥200 min(OR=2.883、P=0.019)均为引起烧伤整形术后感染的危险因素;病原菌检查结果显示,术后感染者中,革兰阳性和阴性球菌感染率分别占35.23%和64.77%;术后感染的主要病原菌为铜绿假单胞菌、金黄色葡萄球菌和大肠埃希菌。结论医院应避免同时使用多种类抗菌药物,适当缩短手术时间和针对性采取措施消除瘢痕褶皱及残余创面,以抑制烧伤整形术后的感染。Objective To investigate the related factors that could cause infection after burn plastic surgery, and to put forward the corresponding treatment measures and recommendations. Methods Total of 88 patients with infection symptoms were collected randomly from January 2013 to December 2015. There were 88 patients without infection were selected during this period as control group. The influencing factors of infection after bum plastic surgery and the countermeasures were analyzed by Univariate analysis and multivariate Logistic regression analysis. Results Univariate analysis showed that there were no signs of scarring, with or without residual wounds, the number of antimicrobial agents and the time of operation were related to postoperative infection of bums. According to the results of multivariate Logistic regression analysis （OR = 2.812, P = 0.026）, scar wounds （OR = 3.148, P = 0.011）, residual wounds （OR = 2.711, P = 0.030） and operation time ≥ 200 （OR = 2.883, P = 0.019） were all the risk factors of postoperative infection, respectively. The pathogen test showed 35.23% and 64.77% of Gram-positive and negative cocci infection. The main pathogens were Pseudomonas aeruginosa, Staphylococcus aureus and Escherichia coll. Conclusions Hospitals should avoid the use of multiple types of antibiotics at the same time, shorten the operation time appropriately and take measures to eliminate scar wrinkles and residual wounds in order to inhibit the infection after bum surgery.

关 键 词：烧伤整形术 感染 危险因素 诊疗对策 

分 类 号：R644[医药卫生—外科学]