开放性手外伤术后感染病原菌特点及影响因素分析  

Analysis of pathogenic bacteria characteristics and risk factors of postoperative infection in open hand injuries

作　　者：黄芳 姚毅 方春辉 Huang Fang;Yao Yi;Fang Chunhui(Department of Hand Surgery,the First People's Hospital of Linping District of Hangzhou,Hangzhou 330113,China)

机构地区：[1]杭州市临平区第一人民医院手外科,杭州330113

出　　处：《中华手外科杂志》2022年第4期298-302,共5页Chinese Journal of Hand Surgery

摘　　要：目的探讨开放性手外伤术后感染的病原菌特点及术后感染的影响因素,为临床开放性手外伤患者感染防控提供参考依据。方法回顾性收集自2018年1月至2020年12月我院手外科收治的开放性手外伤手术患者1526例。按照是否发生感染分为感染组(86例)和对照组(1440例),分析感染组病原菌种类及分布情况,并收集两组一般资料.麻醉及手术等相关指标,采用单因素方差分析及多因素Logistic回归分析筛选开放性手外伤感染的相关影响因素。结果开放性手外伤术后感染率为.5.64%,病原菌以革兰阴性菌感染(60.47%)居多,感染菌株以铜绿假单胞菌(17.44%)、金黄色葡萄球菌(15.12%)、大肠埃希菌(13.95%)多见。单因素方差分析及多因素Logistic回归分析结果显示:年龄(≥60岁)、吸烟史、合并糖尿病受伤到手术时间(≥6 h)、创面污染、负压引流这6个因素为开放性手外伤术后感染的独立影响因素,其中负压引流为保护因素。结论开放性手外伤术后仍有一定的感染率,导致感染的病原菌种类及影响因素也较多。对于患者存在年龄大有吸烟史、合并糖尿病、受伤到手术时间长、创面污染等情况者,临床应重视这些影响因素的参考价值,针对性进行预防控制,以降低开放性手外伤感染率。Objective To explore the characteristics of pathogenic bacteria and risk factors of postoperative infection in patients with open hand injuries,so as to provide reference basis for infection prevention and control in patients with open hand injuries.MethodsFrom January 2018 to December 2020,1526 patients with open hand injuries treated in the department of hand surgery of our hospital were retrospectively collected.According to whether there was infection,they were divided into infection group(86 cases)and control group(1440 cases).The types and distribution of pathogenic bacteria in the infection group were analyzed.The general data,anesthesia,surgery and other related indicators of the two groups were collected.The related risk factors of open hand injury infection were screened by one-way ANOVA and multivariate Logistic regression analysis.ResultsThe postoperative infection rate of open hand injuries was 5.64%.The pathogenic bacteria were mostly Gram-negative bacteria(60.47%),and the infection strains were mainly Pseudomonas aeruginosa(17.44%),Staphylococcus aureus(15.12%)and Escherichia coli(13.95%).The results of One-way ANOVA and multivariate Logistic regression analysis showed that age(above 60 years),smoking history,diabetes mellitus,injury to operation time(more than 6 hours),wound contamination and vacum sealing drainage were the 6 independent factors influencing postoperative infection of open hand injuries,and vacuum sealing drainage was the protective factor.Conclusion There is still a certain postoperative infection rate after open hand injuries,and there are many kinds of pathogenic bacteria and risk factors leading to infection.For patients with large age,smoking history,diabetes mellitus,long injury to operation time,and wound contamination,we should pay attention to the reference value of these factors,and make targeted prevention and control so as to reduce the infection rate of open hand injuries.

关 键 词：手损伤 感染 病原菌 影响因素 

分 类 号：R658.2[医药卫生—外科学] R446.5[医药卫生—临床医学]