手部创面皮瓣修复术后医院切口感染患者的临床特点及影响因素分析  

Clinical characteristics and related influencing factors of wound infection after hand skin flap repair

作　　者：齐朝阳 叶甫国 郑平[1] 王继业[1] 鲍秋红 QI Zhao-yang;YE Pu-guo;ZHENG Ping;WANG Ji-ye;BAO Qiu-hong(Tiantai County Peoplets Hospital, Taizhou , Zhejiang 317200, China)

机构地区：[1]天台县人民医院创伤外科,浙江台州317200

出　　处：《中华医院感染学杂志》2018年第7期1057-1060,共4页Chinese Journal of Nosocomiology

基　　金：浙江省医药卫生基金资助项目(2014KYA226)

摘　　要：目的探讨手部创面皮瓣修复术后医院切口感染临床特点及相关影响因素,为临床治疗和预防提供参考。方法选取于2012年1月-2017年9月医院收治的手部皮瓣移植术患者236例,以无菌注射针对深部切口抽取脓液,以拭子采取浅部切口脓性分泌物,分离鉴定病原菌及药敏试验。分析患者一般资料,包括性别、年龄、受伤原因、皮瓣的手术方式、受伤时手部创面受污染情况、手术时间、住院时间、预防性使用抗菌药物。结果 236例手部创面各类皮瓣修复术患者中有20例发生术后切口感染,感染发生率为8.47%;术后切口感染20例中共分离培养出病原菌34株,其中革兰阳性菌22株占64.71%、革兰阴性菌12株占35.29%;主要革兰阳性菌对青霉素G和红霉素耐药率均为100.00%,主要革兰阳性菌对头孢曲松和头孢呋辛耐药率较高,均>60%;Logistic多元回归分析结果显示,受伤时手部创面受污染严重、手术时间≥1h、住院时间≥7d及预防性使用抗菌药物为术后切口感染的影响因素。结论手部创面皮瓣修复术后医院切口感染病原菌以金黄色葡萄球菌、溶血性链球菌及大肠埃希菌为主,术后切口感染受多种因素影响,临床应规范操作,预防性合理使用抗菌药物,缩短手术和住院时间,以预防切口感染。OBJECTIVE To investigate the clinical characteristics and related influencing factors of wound infection after repair of various types of flaps in hand,so as to provide references for clinical treatment and prevention.METHODS A total of 236 cases of patients with hand skin flap transplantation in our hospital from Jan.2012 to Sep.2017 were selected.Under sterile condition,the incision was disinfected,and the pus was extracted from sterile injection for the deep incision.The purulent secretions were taken for the superficial incision,and the pathogenic bacteria were isolated and identified,and the drug sensitivity test was carried out.The general data of patients were retrospectively analyzed,including gender,age,cause of injury,flap operation type,contamination of hand wound,operation time,length of stay,and prophylactic use of antibiotics.RESULTS Among 236 cases of patients with hand skin flap repair,20 cases of postoperative wound infection were occurred,and the infection rate was 8.47%.Among 20 cases of incision infection,34 strains were isolated and cultured,including 22 strains of gram-positive bacteria accounting for 64.71%and 12 strains of gram-negative bacteria accounting for 35.29%.The resistant rates of main gram-positive bacteria to penicillin G and erythromycin were 100.00%,and mian grampositive bacteria had high resistant rate to ceftriaxone and cefuroxime,which were higher than 60%.Multivariate logistic regression analysis showed that the contamination of hand wound,operation time≥1 h,length of stay≥7 d,and prophylactic use of antibiotics were independent risk factors for postoperative wound infection.CONCLUSION The main pathogens of wound infection after hand skin flap repair were Staphylococcus aureus,Streptococcus pneumoniae and Escherichia coli,and postoperative wound infection was affected by various factors,so we should standardize the operation,preventive use of antibiotics reasonably,and shorten the time of operation and hospitalization,to prevent the infection of incisional infection.

关 键 词：手部皮瓣 切口感染 临床特点 影响因素 

分 类 号：R619.3[医药卫生—外科学]