常用消毒剂对儿童肱骨髁上骨折术后针道维护的效果  

Effectiveness of common disinfectants for postoperative pin tract maintenance of children with supracondylar humeral fractures

作　　者：王南方 张科学[2] 焦娟 白艳玲 毛雪雯 王玉玲[6] WANG Nan-fang;ZHANG Ke-xue;JIAO Juan;BAI Yan-ling;MAO Xue-wen;WANG Yu-ling(PLA Medical School,Beijing 100853,China;不详)

机构地区：[1]解放军医学院,北京100853 [2]解放军总医院第七医学中心小儿外科,北京100010 [3]解放军总医院第七医学中心检验科,北京100010 [4]解放军总医院第一医学中心疾病预防控制科,北京100853 [5]武警山东总队医院泌尿外科,山东济南250014 [6]解放军总医院卫勤训练中心,北京100853

出　　处：《中华医院感染学杂志》2024年第12期1902-1907,共6页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金青年基金资助项目(82101435);解放军总医院"3+1"创新人才建设工程青年科技英才基金资助项目(20230429)。

摘　　要：目的比较临床常用的消毒剂(碘伏、酒精和氯己定)和生理盐水用于儿童肱骨髁上骨折闭合复位经皮穿针术后针道处理的效果.方法选取2022年11月-2023年7月北京市某三甲医院收治的肱骨髁上骨折患儿77例为研究对象,根据术后针道消毒使用消毒剂的种类将患者分为碘伏组(n=19)、酒精组(n=19)、氯己定组(n=19)和生理盐水组(n=20),比较四组针道菌落计数和细菌培养、针道感染分级、消毒疼痛程度和实验室炎性指标[白细胞计数(WBC)、血清淀粉样蛋白A(SAA)、C-反应蛋白(CRP)、白细胞介素(IL)-6、红细胞沉降率(ESR)].结果各组菌落计数结果显示生理盐水组>碘伏组>酒精组>氯己定组(P<0.05);四组细菌培养结果均为阴性;四组针道感染等级差异无统计学意义;疼痛等级结果显示酒精组>碘伏组>生理盐水组>氯己定组(P<0.05);四组CRP差异有统计学意义(P<0.05).结论3种消毒剂用于儿童肱骨髁上骨折术后针道护理均可达到预防感染的效果;综合疼痛、消毒效果和消毒剂对伤口局部的影响三方面考虑,氯己定优于其他3种,更适用于儿童骨折术后针道护理.生理盐水同样可起到预防肱骨髁上骨折术后针道感染的效果.OBJECTIVE To compare the efficacy of commonly used clinical antiseptics(iodophor,alcohol,and chlorhexidine)and normal saline for the management of the pin tract after closed reduction percutaneous pinning surgery of supracondylar humeral fractures in children.METHODS Seventy-seven children with supracondylar humerus fractures admitted to a tertiary hospital in Beijing from Nov.2022 to Jul.2023 were selected as the study subject,and were randomly divided into iodophor group(n=19),alcohol group(n=19),chlorhexidine group(n=19),and normal saline group(n=20)based on the type of disinfectant used for postoperative pin tract disinfection.The four groups were compared in terms of colony counts and bacterial culture,pin tract infection grading,disinfectant pain degree,and laboratory inflammatory biomarkers,inflammatory markers include white blood cell(WBC),serum amyloid A(SAA),C-reactive protein(CRP),interleukin(IL)-6,and erythrocyte sedimentation rate(ESR).RESULTS The results of colony count in each group showed that normal saline group>iodophor group>alcohol group>chlorhexidine group(P<0.05);The results of bacterial culture in all four groups were negative;The difference in the grade of pin tract infection among the four groups was not statistically significant;The results of pain grade showed that the alcohol group>iodophor group>normal saline group>chlorhexidine group(P<0.05);and the difference in CRP among the four groups was statistically significant(P<0.05).CONCLUSION All three disinfectants used for postoperative pin tract care of supracondylar humerus fractures in children could achieve the effect of preventing infection.Considering the combination of pain,disinfecting effect,and the effect of disinfectant on the wound localization,chlorhexidine was better than the other three,which was more suitable for postoperative pin tract care of fracture in children.Normal saline was also effective in preventing postoperative pin tract infections in supracondylar humerus fractures.

关 键 词：肱骨髁上骨折 针道感染 消毒剂 生理盐水 儿童 

分 类 号：R619.3[医药卫生—外科学]