基于倾向性评分匹配法分析手部开放性损伤术后伤口感染的危险因素  

Analysis of risk factors for postoperative wound infection in open hand injuries by propensity score matching

作　　者：刘祥 严伟 Liu Xiang;Yan Wei(Department of Emergency Surgery,Xinyang Central Hospital,Xinyang,Henan Province 464000,China)

机构地区：[1]信阳市中心医院急诊外科,河南信阳464000

出　　处：《创伤外科杂志》2025年第3期225-230,F0003,共7页Journal of Traumatic Surgery

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20200338)。

摘　　要：目的探讨手部开放性损伤术后伤口感染的病原菌分布,并基于倾向性评分匹配(PSM)法分析术后伤口感染的危险因素。方法回顾性分析2019年1月—2022年12月信阳市中心医院行手术治疗的1875例手部开放性损伤患者的临床资料,男性1249例,女性626例;年龄18~78岁,平均42.4岁;挤压辗轧伤790例,切割伤556例,撕脱伤342例,刺伤155例,其他32例。根据术后有无发生伤口感染分为感染组(83例)和非感染组(1792例),应用全自动微生物分析仪自动鉴定病原菌种类。采用PSM法匹配感染组和非感染组基线期协变量,包括性别、年龄、BMI、基础疾病、致伤原因,PSM后采用单因素和多因素Logistic回归分析手部开放性损伤术后伤口感染的危险因素。结果手部开放性损伤患者术后伤口感染发生率为4.43%,以铜绿假单胞菌、大肠埃希菌、金黄色葡萄球菌、表皮葡萄球菌为主要病原菌,革兰氏阴性菌占比较高(53.7%)。PSM后,感染组和非感染组共成功匹配83对患者,两组性别、年龄、BMI、合并基础疾病、致伤原因比较差异无统计学意义(P>0.05)。单因素分析结果显示,感染组和非感染组受伤至手术时间、手术时间、伤口污物残留、术后低白蛋白血症比较差异有统计学意义(P<0.05);多因素分析结果显示,受伤至手术时间≥6 h(OR=2.895,95%CI:1.452~5.771)、手术时间≥3 h(OR=1.802,95%CI:1.185~2.741)、伤口污物残留(OR=4.076,95%CI:1.909~8.702)、术后低白蛋白血症(OR=1.660,95%CI:1.062~2.596)均是手部开放性损伤术后伤口感染的独立危险因素(P<0.05)。结论手部开放性损伤术后伤口感染病原菌以革兰氏阴性菌稍多见(53.7%),经PSM法均衡基线期混杂因素后,受伤至手术时间≥6 h、手术时间≥3 h、伤口污物残留、术后低白蛋白血症均是手部开放性损伤术后伤口感染的独立危险因素。Objective To investigate the distribution of pathogenic bacteria in postoperative wound infection of open hand injuries,and to analyze the risk factors based on propensity score matching(PSM).Methods A retrospective analysis was conducted on the clinical data of 1,875 patients with open hand injuries who underwent surgical treatment at Xinyang Central Hospital from Jan.2019 to Dec.2022,including 1,249 males and 626 females,and the age range was 18 to 78 years,with an average of 42.4 years.There were 790 cases of compression and rolling injuries,556 cutting injuries,342 degloving injuries,155 stabbing injuries,and 32 others.According to the occurrence of wound infection after surgery,patients were divided into infection group(83 cases)and non-infection group(1,792 cases).The pathogenic bacteria were automatically identified using fully automatic microbiological analyzer.The PSM method was used to match baseline covariates between the infected and non-infected groups,including gender,age,body mass index(BMI),underlying diseases,or cause of injury.After PSM,the risk factors for postoperative wound infection in open hand injuries were analyzed using univariate and multivariate Logistic regression analysis.Results The incidence of postoperative wound infection in patients with open hand injuries was 4.43%(95%CI:0.349-0.536).The main pathogens were Pseudomonas aeruginosa,Escherichia coli,Staphylococcus aureus,and Staphylococcus epidermidis,with a relatively high proportion of Gram-negative bacteria(53.7%).After PSM,a total of 83 pairs of patients were successfully matched between the infected and non-infected groups,and there was no statistically significant difference in gender,age,BMI,comorbidities,or cause of injury between the two groups(P>0.05).The results of univariate analysis showed statistically significant differences in terms of time from injury to surgery,operation time,residual dirt at the wound,and postoperative hypoalbuminemia between the two groups(all P<0.05).Multivariate analysis further showed that t

关 键 词：手部开放性损伤 伤口感染 病原菌 危险因素 倾向性评分匹配法 

分 类 号：R619.3[医药卫生—外科学] R378[医药卫生—临床医学]