骨科手术切口感染的临床特征研究与预防措施

目的 探讨手术切口感染的临床特征,分析相关影响因素,提出合理的预防措施,有效降低手术切口感染.方法 回顾性分析1673例经手术治疗的骨科患者,制作统一表格,填写相关数据；分析手术切口感染率、病原菌类型,并采用x2检验对相关因素进行分析.结果 1673例患者共发生手术切口感染41例,感染率为2.45％；革兰阴性菌28株,占68.29％,革兰阳性菌13株,占31.71％,分布最多的3种病原菌为铜绿假单胞菌、金黄色葡萄球菌及大肠埃希菌,分别占26.83％、24.39％、17.07％；手术切口感染与骨折类型、麻醉方式、手术切口类型、手术持续时间、年龄、手术时机、是否有糖尿病、术前是否存在其他部位感染和有无人员参观等有关(P＜0.05),而与性别无关.结论 骨科手术切口感染率相对较高,其主要病原菌为铜绿假单胞菌和金黄色葡萄球菌,感染诱因较多,应针对多种影响因素加强预防,尤其是应加强Ⅲ类手术切口、开放性骨折、糖尿病和术前其他部位存在感染患者的预防工作.

Clinical characteristics of orthopedic surgery incision infections and prevention measures

OBJECTIVE To explore the clinical characteristic of the surgical incision infections,analyze the related factors,provide reasonable preventive measures,so as to decrease the incidence of surgical incision infections.METHODS A total of 1673 patients undergoing orthopedic surgery in orthopedic department were retrospectively analyzed.The tables were made and the data were filled according to the clinical data.The incidence of operative incision and the type of pathogens were observed.The related factors were analyzed by χ2 test.RESULTS The surgical incision infections occurred in 41 cases with the infection rate of 2.45%.Totally 28 strains(68.29%) of gram-negative bacteria and 13 strains(31.71%) of gram-positive bacteria were isolated.The three main pathogens were Pseudomonas aeruginosa(26.83%),Staphylococcus aureus(24.39%) and Escherichia coli(17.07%).By χ2 test,it showed that the incidence of the surgical incision infections was related to fracture type,anesthesia methods,type of surgical incision,operation duration,age,the operation chance,diabetes,coexistence of other site infections before the surgery,and the personnel to visit(P<0.05),and it was not correlated with the gender.CONCLUSION The incidence of the surgical incision infections is relatively high in the orthopedic department,and the P.aeruginosa and S.aureus are the main pathogens,there are many predisposing factors for the infections.We should take some preventive measures,according to the related factors,especially for the patients with type Ⅲ surgical incision,open fractures,diabetes,and coexistence of other site infections.