骨科清洁切口手术部位感染的危险因素分析

目的 分析骨科清洁切口手术部位感染（SSI）的危险因素，总结降低骨科清洁切口SSI发病率的经验。方法 对某医院2015年6月-2016年12月实施骨科清洁手术的患者进行SSI监测，结合国内外文献中常见骨科术后SSI高危因素：患者高龄、ASA评分高、传统备皮方法、手术时间长、手术类型复杂、不合理使用抗菌药物、留置引流管等进行统计并行单因素卡方检验，筛选出阳性危险因素，对阳性危险因素进行多因素Logistic回归分析。结果 共监测患者792例，发生SSI 17例，SSI发病率为2.15%。单因素分析结果显示，患者高龄、ASA评分Ⅱ级及以上、传统备皮方法、手术时间长、手术类型复杂、不合理使用抗菌药物是骨科清洁切口SSI相关阳性危险因素（均P<0.05）。患者性别、手术医生（主刀）的级别和操作技巧、留置引流管与术后SSI无相关性。多因素logistic分析结果显示：患者ASA评分Ⅱ级及以上、传统备皮法、手术时间＞3h会增加骨科清洁手术后SSI的风险，其中手术时间＞3h导致的SSI风险最高（OR: 4.08, 95%CI: 1.36-12.35），其次是患者ASA评分Ⅱ级及以上（OR: 3.46，95%CI：1.98-21.12），而传统备皮法在所有阳性危险因素中风险最小（OR:2.97，95%CI：1.08-14.71）。结论 患者ASA评分Ⅱ级及以上、传统备皮法、手术时间＞3h会增加骨科清洁手术后SSI的风险，医务人员应充分认识和了解这些危险因素，在围手术期最大可能地优化各项可调控因素，最大限度地降低骨科清洁切口SSI的发生率。

Analysis on risk factors for clean wound orthopedic surgical site infection

Objective To analyze the risk factors for surgical site infection (SSI) in clean wound orthopedics surgery, and to explore how to control it. . Methods SSI among patients receiving clean wound orthopedic surgery from June 2015 to December 2016 were monitored, Chi-square test was used to analyze the related influencing factors(age, ASA score, skin preparation modes, operation time, types of surgery , use of Antibacterials, drainage tube indwelling) of postoperative infection in clean wound orthopedics surgery, multiple Logistic regressions were used to analyze the positive risk factors. Results A total of 792 patients were monitored, 17 cases (2.15%) of SSI occurred. The results of chi-square test showed that elder age，ASA score ≥ grade Ⅱ,conventional skin preparation, long operation time, complicated operation type , irrational use of antibiotics might increase the risk of clean wound orthopedic surgical infection (all P values <0.05)，but patients’ gender, the surgeons’ level and operation skill , drainage tube indwelling did not. Multiple Logistic regressions results showed that ASA score ≥ grade Ⅱ,conventional skin preparation and long operation time might increase the risk the clean wound orthopedic surgical infection，and the highest risk factors was long operation time(＞3h), and then ASA score ≥ grade Ⅱ and conventional skin preparation. [OR (95%CI), 4.08(1.36-12.35),3.46(1.98-21.12),2.97 (1.08-14.71)]. Conclusion Elder age，ASA score ≥ grade Ⅱ and conventional skin preparation may increase the risk of clean wound orthopedic surgical infection. Medical staff should be fully aware of these risk factors, optimize the regulatory factors most in perioperative period and maximally reduce the incidence for SSI in clean wound orthopedics surgery.