下肢创面皮瓣修复术后院内切口感染情况及其影响因素分析  

Analysis of Infection of Nosocomial Incision and Its Influencing Factors after Repair of Lower Extremity Wound Skin Flap

作　　者：蒲晓姝 蒋婷[1] 张兰芳[1] 刘鸿雁[1] PU Xiaoshu;JIANG Ting;ZHANG Lanfang(The Second Clinical Medical College of Nanchong North Sichuan Medical College, Sichuan Nanchong 637000, China)

机构地区：[1]川北医学院第二临床医学院南充市中心医院烧伤整形美容外科,四川南充637000

出　　处：《河北医学》2021年第11期1866-1871,共6页Hebei Medicine

基　　金：四川省教育厅重点科研项目,(编号:17ZA0181)。

摘　　要：目的:探讨下肢创面皮瓣修复术后院内切口感染情况及其影响因素。方法:选择2017年1月至2020年12月在我院行下肢创面皮瓣修复术的282例患者进行回顾性分析。收集可能影响患者院内切口感染的因素,根据有无院内切口感染将患者分为感染组与未感染组,比较两组患者各病历资料,并采用多因素Logistic回归分析对单因素分析中具显著性差异的因素进行综合分析。结果:本研究纳入的282例下肢创面皮瓣修复术患者中共有23例出现切口感染,感染率为8.16%。在23例患者中共分离培养出36株病原菌,其中革兰氏阳性菌占61.11%,革兰氏阴性菌占33.33%,真菌占5.56%。单因素分析基础上多因素分析结果显示:伤后就诊时间延长、手术时间延长、住院时间延长、使用糖皮质激素及有糖尿病史为下肢创面皮瓣修复术后院内切口感染的危险因素,皮瓣面积超过创面面积10%及以下、使用预防性抗菌药物为保护因素(P<0.05)。结论:下肢创面皮瓣修复术后院内切口感染率较高,以革兰氏阳性菌感染为主,其主要受患者伤后就诊时间、手术时间、住院时间等因素的影响,临床上可针对上述因素进行针对性干预以降低此类患者院内切口感染的发生率。Objective:To investigate the infection of the nosocomial incision and its influencing factors after the repair of the lower limb wound flap.Methods:282 patients who underwent lower extremity wound flap repair in our hospital from January 2017 to December 2020 were selected for retrospective analysis.The factors that may affect the nosocomial incision infection were collected.According to the presence or absence of nosocomial incision infection,the patients were divided into infected group and uninfected group.The medical records of the two groups were compared,and the factors with significant differences in univariate analysis were comprehensively analyzed by multivariate logistic regression analysis.Results:A total of 23 of the 282 patients undergoing skin flap repair of lower limb wounds included in this study had incision infection,and the infection rate was 8.16%.A total of 36 pathogenic bacteria were isolated and cultured in 23 patients,of which gram-positive bacteria accounted for 61.11%,gram-negative bacteria accounted for 33.33%,and fungi accounted for 5.56%.On the basis of univariate analysis and multivariate analysis,the results showed that the risk factors of nosocomial incision infection after lower limb skin flap repair were the prolongation of post injury visit time,operation time,hospital stay,glucocorticoid use and diabetes history,and the protective factors were the skin lesion area more than 10%of the wound area and the use of preventive antibiotics(P<0.05).Conclusion:The rate of nosocomial incision infection after lower limb skin flap repair is high,mainly Gram-positive infection,which is mainly affected by the time of treatment,operation time,hospital stay and other factors.In clinical practice,targeted intervention can be carried out for the above factors to reduce the incidence of nosocomial incision infection in such patients.

关 键 词：下肢创面 皮瓣修复术 院内切口感染 多因素分析 

分 类 号：R47[医药卫生—护理学]