手外科术后患者细菌感染监测及影响因素分析

Monitoring of postoperative bacterial infection in hand surgery patients and influencing factors

目的探讨手外科术后患者细菌感染情况及影响因素。方法选取2013年4月-2016年10月实施开放性手部外科手术的1 568例患者临床资料进行回顾性分析。统计术后感染发生率、病原菌分布情况;收集患者年龄、伤后就诊时间、手术时间、伴随基础疾病等临床资料,单因素及多因素分析发生术后感染的影响因素;ELISA法检测术后伤口感染患者围术期血清中炎性细胞因子(TNF-α、IL-6、IL-10)水平变化情况。结果 1 568例实施手部开放性手术的患者中,55例患者发生术后伤口感染,术后感染发生率为3.51%;55例术后感染患者伤口感染标本共检出病原菌株70株,其中革兰阳性菌44株占62.86%,革兰阴性菌26株占37.14%;多因素Logistic回归分析结果显示,年龄≥50岁、伤后就诊时间≥6h、手术时间≥2h、伴随基础疾病、重度创面污染是发生外科术后感染的影响因素;感染患者术后血清TNF-α水平逐渐下降,IL-6、IL-10水平在术后3、5天时明显升高,之后逐渐下降(P<0.05)。结论开放性手外伤术后感染以革兰阳性菌为主,年龄≥50岁、伤后就诊≥6h、手术时间≥2h、伴随基础疾病、创面污染是外科术后细菌感染的影响因素,使用预防性抗菌药物为保护性因素。对围术期手外伤患者进行血清炎性细胞因子水平变化检测,有助于病情评估。

OBJECTIVE To explore the prevalence of postoperative bacterial infection in the hand surgery patients and analyze the influencing factors.METHODS The clinical data of 1 568 patients who received open hand surgery from Apr 2013 to Oct 2016 were retrospectively analyzed.The incidence rates of postoperative infection and species of pathogens were statistically analyzed.The clinical data were collected from the patients,including age,interval between injury and surgery,operation duration and underlying diseases;univariate analysis and multivariate analysis were performed for influencing factors for the postoperative infection;the levels of perioperative serum inflammatory cytokines（TNF-α,IL-6,IL-10）of the patients with postoperative wound infection were determined by using ELISA.RESULTS Of the 1 568 patients who received the open hand surgery,55 had postoperative wound infection,with the incidence rate 3.51%.A total of 70 strains of pathogens were isolated from the specimens of the 55 patients with postoperative wound infection,44（62.86%）of which were gram-positive bacteria,26（37.14%）were gram-negative bacteria.The result of multivariate logistic regression analysis indicated that the no less than 50 years of age,interval between injury and surgery no less than 6 hours,operation duration no less than2,complication with underlying diseases and severe wound contamination were the influencing factors for the postoperative infection.The serum TNF-αlevel of the patients with postoperative infection declined gradually,the levels of IL-6 and IL-10 were remarkably elevated after the surgery for 3 and 5 days and then were gradually decreased（P〈0.05）.CONCLUSIONS The gram-positive bacteria are the major pathogens causing the postoperative infection in the open hand surgery patients.The no less than 50 years of age,interval between injury and surgery no less than 6 hours,operation duration no less than 2,complication with underlying diseases and wound contamination are the influencing factors for the postoperative bacterial infection;the prophylactic use of antibiotics is the protective factor.The detection of the postoperative serum inflammatory cytokines of the hand injury patients may facilitate the evaluation of illness condition.