四肢开放性骨折患者感染的影响因素分析与对策

Analysis of Influencing Factors of Wound Infection Resulted from Limbs Open Fracture and Nursing Strategy

目的探讨四肢开放性骨折患者合并感染的危险因素,为相关护理干预措施提供依据。方法 2007年10月—2009年12月在骨伤科住院及门诊就诊,经细菌培养明确诊断为四肢开放性骨折合并创面感染的患者100例,设为病例组。对照组为按性别、年龄、损伤部位、损伤程度、致伤原因频数匹配的同时段内同科室住院及门诊就诊患者200例,均为四肢开放性骨折未合并有创面感染的患者。采用病例对照研究,设计调查表收集相关危险因素。对可疑危险因素采用Logistic回归模型分析,筛选四肢开放性骨折并发创面感染的危险因素。结果有感染倾向时未及时处理、使用钢板、术后管理不当、使用髓内钉、创口遗留死腔、至医院清创时间>6 h、至医院就诊时间>6 h、院前治疗不当为四肢开放性骨折患者合并感染的危险因素,OR值分别为5.523、5.045、4.266、4.134、3.408、3.353、2.319、1.871,使用外固定支架为保护因素,OR值为0.005,使用螺丝钉+钢丝内固定无统计学意义。结论四肢开放性骨折患者合并创面感染的危险因素贯穿于发病到治疗的全过程,应加强相关健康知识普及,减少危险因素,降低感染的发生率。

Objective To explore related risk factors of the wound infection resulted from limbs open fracture and provide evidence for interventions and measures of nursing. Methods From October 2007 to December 2009, a 1：2 matched case-eontrol study was designed. The case group included 100 cases of wound infection with limbs open fracture and the control group included 200 patients with corresponding gender, age, injured reason, severity and location. The suspected risk factors were analyzed by logistic regression model, then boltinged the risk factors that resulted in wound infection in limbs open fracture patients. Results The result demonstrated that risk factors contained not dealing with infection tendency, the plate fixation, bad management after surgery, the intramedullary pin fixation, wound with dead space, over-6-hour debridement time and the therapy time, pre-hospital improper treatment （OR were 5.523, 5.045, 4.266, 4.134, 3.408, 3.353, 2.319, 1.871）, while the protective factor was external fixation apparatus （OR=0.005）. Conclusion The risk factors of the wound infection resulted from limbs open fracture were throughout courses from injure to therapy, and related measurements of nursing must be performed reasonably throughout the whole course.