开放性骨折患者伤口感染原因分析及预防对策

Causes and countermeasures of wound infection in open fracture patients

目的调查分析开放性骨折患者伤口感染的原因,探讨预防的措施。方法采用回顾性方法调查2008-2009年收治并作过细菌培养的开放性骨折患者伤口感染发生情况。结果 334例患者中发生伤口感染者共65例,感染率为19.5%,感染菌中革兰阴性杆菌和革兰阳性球菌分别占62.0%和32.9%;感染发生率以足部骨折和胫腓骨骨折较高,分别为24.6%和22.5%;有65.5%的患者在骨折后3 d内细菌培养阳性,≥5 d阳性的为34.5%;软组织损伤程度与感染的发生率依次为轻度(10.3%)、中度(17.3%)和重度(37.7%)。结论及时、彻底清创和应用抗菌药物,严格无菌操作,保持治疗环境的无菌化,是减少开放性骨折伤口感染的有效措施。

OBJECTIVE To analyze what caused the infection in open fracture patients and how to prevent it. METHODS The occurrence of infection in open fracture patients admitted to the hospital from 2008 to 2009 was investigated with retrospective method. RESULTS There were 65 infection cases in 334 open fracture patients, the total rate of infection was 19. 5~, Gram-negative bacilli and Gram-positive cocci accounted for 62. 0% and 32.9%, respectively. Foot fracture and tibia and fibula fracture had the higher rate of infection with 24.6% and 22.5 %, respectively. The positive bacterial culture had occurred in 65.5 % of patients after the fracture within 3 days, the positive bacterial culture had occurred in 34.5 % of patients after the fracture for more than 5 days. The damage degrees of soft tissue and the infection rates were respectively as the followings：mild degree （10：3 %）, moderate degree （17. 3%） and severe degree （37. 7%）. CONCLUSION To clean the wound in time and thoroughly, perform the aseptic operation strictly and keep the treatment environment sterilized are the effective measures to reduce the infection in open fracture patients.