颌骨骨折患者术后医院感染的临床特点及影响因素研究  

Clinical characteristics and risk factors of nosocomial infections after jaw fracture

作　　者：张景波[1] 陈立忠[2] 汤婷[1] 张伯俊[1] 李姝蓉 ZHANG Jing-bo;CHEN Li-zhong;TANG Ting;ZHANG Bo-jun;LI Shu-rong(The Second Affiliated Hospital of Kunming Medical University,Kunrning,Yunnan 650101,China)

机构地区：[1]昆明医科大学第二附属医院整形外科,云南昆明650101 [2]昆明医科大学附属口腔医院口腔内科,云南昆明650106

出　　处：《中华医院感染学杂志》2018年第15期2353-2356,共4页Chinese Journal of Nosocomiology

基　　金：云南省昆明市科技计划基金资助项目(2015033)

摘　　要：目的探讨颌骨骨折患者术后医院感染的临床特点,并对相关影响因素进行进一步探究。方法选择2014年3月-2017年1月于医院行手术治疗的颌骨骨折的患者362例为研究对象,用无菌棉签采集患者术后分泌物,分析病原菌分布特点,详细记录患者年龄、性别、手术固定时机、营养情况、切口类型、创伤程度、固定方式、相关基础性疾病、侵入性操作、抗菌药物使用情况及术后口腔卫生状况等因素,对相关因素进行单因素及多因素Logistic回归分析。结果 362例颌骨骨折患者术后共83例患者发生医院感染,感染率为22.93%;83例患者医院感染的部位以呼吸道感染为主,占34.94%;83例术后医院感染患者共检出病原菌121株,其中革兰阴性菌72株占59.50%、革兰阳性菌37株占30.58%、真菌12株占9.92%;多因素Logistic回归分析结果显示,创伤程度、预防性抗菌药物使用、相关侵入性操作、术后口腔卫生状况及住院时间是导致颌骨骨折术后患者发生医院感染的影响因素(P<0.05)。结论对于颌骨骨折术后医院感染的患者一定要合理给予抗菌药物治疗,同时根据其导致医院感染的相关影响因素采取综合干预措施,这对于降低医院感染率和改善患者预后有着重要意义。OBJECTIVE To investigate the clinical characteristics of nosocomial infections after jaw fractures,and to explore the related risk factors.METHODS A total of 362 patients with jaw fractures treated with surgery from Mar.2014 to Jan.2017 were selected.The postoperative secretions from patients were collected with sterile cotton swabs.The distribution characteristics of pathogens were analyzed.The factors such as age,genders,timing of operation,nutritional status,types of incision,degree of trauma,fixation,related underlying diseases,invasive operation,antibiotic use and postoperative oral hygiene were recorded in detail.Univariate analysis and multivariable logistic regression analysis were used to analyze the related factors.RESULTS A total of 83 patients with jaw fractures had nosocomial infection with an infections rate of 22.93%.The main infection site of 83 cases of nosocomial infection was respiratory tract infection accounting for 34.94%.Totally 121 strains of pathogens were detected in 83 cases of patients with nosocomial infections,including 72 strains of gram-negative bacteria accounting for59.50%,37 strains of gram-positive bacteria accounting for 30.58%,and 12 strains of fungi accounting for 9.92%.Multivariable logistic regression analysis showed that trauma degree,the use of preventive antibiotics,related invasion operation,postoperative oral hygiene and hospitalization time were the risk factors for postoperative nosocomial infections in patients with jaw fractures（P〈0.05）.CONCLUSIONIt is important for patients with nosocomial infections after jaw fractures to be treated with antibiotics,and to take comprehensive intervention measures according to the related risk factors of nosocomial infections.This is of great significance for reducing the nosocomial infection rate and improving the prognosis of patients.

关 键 词：颌骨骨折 医院感染 临床特点 影响因素 

分 类 号：R181.3[医药卫生—流行病学]