人工全髋关节置换术中飞溅散落物的细菌学分析

Bacteriological analysis of spatters during total hip replacement

目的探讨人工全髋关节置换术（THA）术中飞溅散落物细菌培养和药敏结果特点,分析引起术后感染的相关因素,提出预防感染措施。方法对2000年1月~2008年12月本院开展的342例THA术中的45例,术中飞溅物散落于手术无菌区和术者有菌区的270点散落物进行细菌培养和药敏结果分析。结果 22例未佩戴无菌防护面罩组细菌培养结果无菌区出现1点阳性结果,阳性率1.45%,有菌区共3点阳性,阳性率4.35%,无菌区及有菌区总阳性率2.90%;而佩戴无菌防护面罩组细菌培养结果全部为阴性。结论术者自身携带的含菌量可能是引起THA术后感染的危险因素之一,应采取改变操作模式,严格手术室无菌规章制度,保证在层流的清洁环境中进行无菌操作,重视人工全髋关节置换术围手术期和手术过程中每个环节,建立完善的防止THA术后感染的措施。

Objective To discuss the results of bacteria culture and the drug sensitive assay,as well as the related factors in postoperative infection of total hip replacement and to give advices on the management for preventing the infection.Methods From Jan 2000 to Dec 2008,45 cases who had total hip replacement were chosen.270 spatters splashing into the aseptic area and non-aseptic area were sent for bacteria culture and drug sensitive assay.Results As for the bacteria culture,there were 3 positive results from non-aseptic area and 1 positive result from aseptic area in 22 cases of non-mask wearing operations.So the positive rates were 4.35% and 1.45% respectively,and the total positive rate was 2.90%.The bacteria culture results were all negative in mask wearing operations.Conclusions The bacterium carried by the staff in operation may be one of the risk factors of the post operative infection in total hip replacement.The operating pattern should be changed,while the rules and regulations should be well organized in order to insure the aseptic techniques in the laminar-flow sterile environment.Every steps related to the operation should be carefully considered and paid much attention to.It is important to set up principles and improve the management of operating rooms so as to prevent the infection in total hip replacement.