自制隔离架在下肢关节置换术的应用  

The application of spacer in lower limb joint replacement

作　　者：朱明达 梁华 冯军贤 李泽仁 ZHU Mingda;LIANG Hua;FENG Junxian;LI Zeren(Department of Anesthesiology,The 942th Hospital of the PLA,Yinchuan 750004,China)

机构地区：[1]解放军第九四二医院麻醉手术科

出　　处：《麻醉安全与质控》2019年第4期211-215,共5页Perioperative Safety and Quality Assurance

基　　金：宁夏回族自治区科技攻关计划项目(20112YS274)

摘　　要：目的探讨自制隔离架在下肢关节置换手术中的应用。方法选取我院2016-01/2019-03期间在静脉快通道麻醉下行下肢关节置换术患者50例,采用单纯随机法将患者分为对照组(A组,n=25)和试验组(B组,n=25),其中男21例,女29例,年龄25~65岁,体质量指数(BMI)20.52~27.6kg/m2,ASA分级Ⅰ或Ⅱ级。手术均在百级层流手术间内进行。测定术前2h静态条件下手术室沉降菌落数。A组:使用手术床自带头架,高度铺设60cm,宽度50cm。B组:使用自制关节置换手术隔离架,高度铺设180cm,宽度150cm。将4个培养皿放置在4个区域中,分别为:头架或隔离架一侧的无菌手术区,无菌手术区外围;头架或隔离架另一侧的头侧层流区,头侧层流区域外围,培养皿均在37℃下培养48h,记录4组培养皿动态条件下沉降菌落个数,A组记为a1、a2、a3、a4,B组记为b1、b2、b3、b4。结果A、B2组术前静态条件下沉降菌浓度≤0.2cfu/30minΦ90皿。A组:a1与a2、a4培养皿细菌菌落数比较,差异有统计学意义(P<0.05);a1与a3细菌菌落数比较,差异无统计学意义(P>0.05)。B组:b1与b2、b3、b4细菌菌落数比较,差异有统计学意义(P<0.01)。A、B2组组间动态条件下沉降菌落数比较,a1、b1细菌菌落数比较,差异有统计学意义(P<0.01);a2、b2,a3、b3,a4、b4细菌菌落数比较,差异均无统计学意义(P>0.05)。经追踪调查,A组与B组90d内患者切口发生感染分别为2例与0例,B组感染发生率较低,二者感染率差异无统计学意义(P>0.05)。结论应用自制关节置换手术隔离架可以使下肢关节置换术手术区域更加洁净,减少手术区域污染程度。Objective To discuss the application of the spacer in lower limb joint replacement surgery.Methods Fifty American Society of Anesthesiologists physical statusⅠorⅡpatients,aged 25-65 years,with body mass index(BMI)of 20.52-27.60 kg/m 2,undergoing lower limb joint replacement in the 942th Hospital of the PLA from January 2016 to March 2019 were randomly divided into two groups(n=25 each):control group(group A)and experimental group(group B).All operations were performed in hundred-level laminar flow operating room.The number of settlement colonies in the operating room was determined under static condition 2 h before the operation.Group A:the operation bed had a self-headed frame with a height of 60 cm and a width of 50 cm.Group B:the self-made isolation frame for joint replacement was used,with a height of 180 cm and a width of 150 cm.Four petri dishes were placed in four areas,namely the sterile operation area on one side of the head frame or the isolation frame,the periphery of the sterile operation area,the head side laminar flow area of the other side of the head frame or the isolation frame,and the periphery of the head side laminar flow area.Petri dishes were cultivated at 37℃for 48 h and the number of settlement colonies of petri dishes were recorded under dynamic condition.The data of group A and group B were respectively recorded as a1,a2,a3,a4 and b1,b2,b3,b4.Results The preoperative bacteria counts of both groups were lower than 0.2 cfu/(30 min·Φ90 petri dish)under static condition.In group A,the number of bacterial colonies of a1 was compared with that of a2 and a4 respectively.The difference between these groups was statistically significant(P<0.05).There was no significant difference between the number of bacterial colonies of a1 and that of a3.In group B,there was significant difference between the number of bacterial colonies of b1 and that of b2,b3 and b4 respectively(P<0.01).Compared with the number of bacterial colonies of a1 with that of b1,the difference between two groups was statisti

关 键 词：关节置换术 手术部位感染 手术室 

分 类 号：R614[医药卫生—麻醉学]