多发性创伤患者腹部术后切口感染的影响因素及病原学分析  

The risk factors of post-operative incision infection in multiple trauma patients and their etiology

作　　者：贺强贵[1] 程水兵[1] 徐洪波[1] 谢先海[1] 吴广宇[1] 徐建军 HE Qiang-gui;CHENG Shui-bing;XU Hong-bo;XIE Xian-Hai;WU Guang-yu;XU Jian-jun(The First Affiliated Hospital of Wenzhou Medical University,Wenzhou,Zhejiang 325000,China)

机构地区：[1]温州医科大学附属第一医院创伤外科,浙江温州325000 [2]温州医科大学附属第一医院烧伤科,浙江温州325000

出　　处：《中华医院感染学杂志》2018年第22期3442-3445,共4页Chinese Journal of Nosocomiology

基　　金：浙江省自然科学基金资助项目(LY15H160058);温州市科技局计划基金资助项目(Y20170422)

摘　　要：目的探讨多发性创伤患者腹部术后切口感染的危险因素及病原学特征,为临床防治提供参考依据。方法回顾性分析2013年4月-2017年1月医院收治的308例多发性创伤行腹部手术患者的临床病例资料,统计患者术后切口感染情况、病原菌分布,运用单因素及多因素Logistic线性回归方法分析影响术后切口感染的危险因素。结果 308例多发性创伤患者共有106例发生术后切口感染,感染率为34.42%,病原体分析共培养出致病菌147株,其中最多的是革兰阴性菌88株占59.86%、其次是革兰阳性菌46株占31.29%、真菌13株占8.84%;单因素分析结果显示,两组患者在合并糖尿病、年龄、住院时间、出血量、创伤指数、白细胞、C-反应蛋白、白蛋白方面比较,差异具有统计学意义(P<0.05);多因素Logistic回归分析结果表明,高龄、糖尿病、创伤指数增加、白蛋白降低是多发性创伤患者发生腹部术后切口感染的影响因素(P<0.05)。结论多发性创伤患者腹部术后切口感染风险较高,以革兰阴性菌为主,感染的发生与多种因素密切相关,临床需积极评估患者病情,早期经验性使用抗菌药物,特别注意加用对革兰阴性菌敏感的药物,防止感染的扩散或进展。OBJECTIVE To explore the risk factors and etiological characteristics of post-operative incision infection in multiple trauma patients,and provide a reference basis for clinical prevention and treatment.METHODS A retrospective analysis was conducted for the clinical data of 308 cases of multiple trauma patients with abdominal surgery conducted in Apr.2013-Jan.2017.Statistical analysis of postoperative incision infection and pathogen distribution in these patients was conducted,and the risk factors influencing the postoperative incision infection were analyzed using univariate and multivariate logistic linear regression methods.RESULTS Among the 308 cases of multiple trauma patients,a total of 106 cases of postoperative incision infection occurred,and the infection rate was 34.42%.A total of 147 strains of pathogens were isolated,dominated by gram-negative bacteria（88 strains,accounting for 59.86%）,followed by gram positive bacteria（46 strains,accounting for 31.29%）,and fungi（13 strains,accounting for 8.84%）.The univariate analysis suggested significant differences in diabetes complication,age,hospital stay,amount of bleeding,trauma index,leukocyte,C-reactive protein and albumin between the two groups（P〈0.05）.The multivariate logistic regression analysis results showed that the older age,diabetes,increased trauma index and reduced albumin level were independent risk factors for postoperative abdominal incision infection in multiple trauma patients（P〈0.05）.CONCLUSIONThere is a relatively high risk of postoperative abdominal incision infection in multiple trauma patients,and the pathogens are dominated by gram-negative bacteria.The infection is closely related to many factors.Active clinical evaluation of the patients′condition is necessary,and early empirical use of antimicrobial drugs is suggested,with special attention paid to use of antibiotics against gram-negative bacteria,so as to prevent the spread or progress of the infection.

关 键 词：多发性创伤 切口感染 影响因素 病原学 

分 类 号：R619.3[医药卫生—外科学]