汶川地震伤员不同救治时期伤口感染情况分析

Analysis on wound infection of patients at different periods after Chinese Wenchuan earthquake

目的探讨如何降低地震灾害后伤员伤口感染率及伤肢截肢率。方法分析汶川地震后前方、后方医院收治伤员592例的伤口感染情况及治疗效果。结果伤后8h以内送达前方医院的伤员，开放性伤口感染率为30．7％。伤后8h以后送达前方医院者，开放性伤口感染率为79．9％。其中因气性坏疽截肢1例（0．17％），其他严重感染截肢5例（1．2％）。闭合性损伤行择期手术后伤口感染率为7．1％。送达后方医院的伤员，开放性伤口均已在现场急救时或前方医院早期行清创、抗感染等治疗，其伤口感染率为50．8％，无截肢或在前方医院已经截肢。闭合性损伤者，行择期手术后伤口感染率为0。前、后方医院伤口感染主要细菌种类为粪肠球菌、大肠埃希菌等常见细菌。混合感染者多于单细菌感染，G^-菌感染者多于G^-菌感染。大部分感染伤口经敏感抗生素治疗后，感染得到有效控制。结论地震后开放性损伤伤员的伤口感染率高，因严重感染导致的截肢率高，在不同救治时期，均应该尽快彻底清创、早期抗感染后行外固定治疗，减少内固定。闭合性损伤伤员在前方医院择期手术后感染率明显高于后方医院。因此，在生命征平稳时应尽量送到后方医院治疗，可降低伤口感染率。

Objective To discuss how to reduce the incidence of postoperative infection and amputation of patients after earthquake. Methods The wound infection and corresponding therapeutic outcome were analyzed in 592 patients in front line hospitals and station hospitals. Results The incidence of infection was 30.7% in patients treated in front hospital within 8 hours post-trauma but 79.9% after 8 hours post-trauma. There included 1 patient （0.2%） with amputation due to clostridial myonecrosis and 5 （ 1.2% ） with amputation due to serious infection. Incidence of postoperative wound infection was 7.1% after selective operation for close injury. The incidence of infection in patients in station hospitals was 50.8%, with no amputation, because they received debridement and antibiotics in site or front line hospitals. No postoperative infection was found in patients with close injury treated with selective operation in station hospitals. The major bacteria of wound infection in either front line hospitals or station hospitals were enterococcus faecalis and Eschrichia Coli. Incidence of combined infection was higher than that of single infection, and Gram-Negative bacillus infection exceeded Gram-Positive bacillus infection. The major wound infection obtained effective control through treatment with sensitive antibiotics. Conclusions After earthquake, the incidence of infection in patients with open injury is high, with high amputation rate due to serious infection. Therefore, we propose performing as soon as possible debridement and external fixation with antibiotic treatment but reducing internal fixation. The postoperative infection rate of patients with close injury in front line hospitals is much higher than that in station hospitals; therefore, patients with stable vital signs should be transported to station hospitals as early as possible in order to reduce incidence of infection.