狂犬病暴露及伤口处理效果研究

Effect of wound treatment after exposure to rabies HE Fan,

目的探讨可疑狂犬病暴露后的有效处理方式，并对其效果进行评价，为更好地防治狂犬病提供科学依据。方法通过对浙江省2005至2006年的所有狂犬病病例和与其有同源暴露的狂犬病暴露者的调查，利用病例对照研究方法，采用非条件Lo-gistic回归方法，分析有效的伤口处理方式并评价其效果。结果本次共调查了132例病例和73例对照。病例组和对照组ll度及以上暴露分别占97.7％和91．8％，相对Ⅰ度暴露，OR值为3．73（090～15．40）及以上。病例组和对照组各有8．5％和1．4％暴露部位在头面部，57．4％在躯干，31．0％在上肢；相对下肢，OR值分别为3．67（1．96～6．87）、12．00（1．49-9679），存在剂量反应关系（趋势X^2=20．88，P=0．000）。22．6％的病例和11．8％的对照暴露部位数≥2处，OR值为2．19（0．88～5．58）；84．8％的病例和712％的对照伤口有出血，OR值为226（107～4．80）；伤口在医疗机构处理为保护因素，相对伤口未处理者，OR值为047（0．25～088）；8018％的病例和97．4％的对照伤口在当日处理，OR值为0．11（001～0．90）；消毒或冲洗后再消毒为有效的伤口处理方式，相对伤口未处理者，OR值分别为0128（0．10～0．76）和0．33（013～0．80）。结论暴露程度、暴露部位和暴露部位数、伤口有无出血、伤口处理和处理方式、伤口处理时间对狂犬病暴露者的发病有影响，狂犬病暴露后应在医疗机构当天及时对伤口进行消毒处理。

Objective To evaluate the methods of wound treatment after exposure to rabiest. Methods A Case-control study was conducted in 2005 and 2006 including 132 rabies patients （case） and 73 non-patients exposed to homologous rabies （control）. Non-conditional logistic regression was used to analyze the effective methods of wound treatment and to evaluate its effect. Results 132 cases and controls were investigated. Compared to grade I exposure, 97.7% of cases and 91.8% of controls had grade II and III exposure （OR=3.73, 95%C1：0.90 - 15.40）. Compared to lower limb, 8.5% of cases and 1.45% o1 controls were exposed at head and face （OR=3.67, 95% C1：1.96 -6.87）, 57.4% of cases and 31.0% of controls were at upper limb and trunk （OR= 12.00, 95%C1： 1.49- 96.79） （Chi-square trend： Chi-square=20.88, P=0.000）. 22.6% of cases and 11.8% of controls had more than 1 exposure location （OR=2.19, 95%C1： 0.88- 5.58）, 84.8% of cases and 71.2% of controls had blood in wounds （OR=2.26, 95%C1：1.07 - 4.80）. Treatment on wounds in medical institutions was a protection factor, with a OR of 0.47（95% Cl： 0.25 - 0.88） as compared with those untreated patients. 80.8% of cases and 97.4% of controls dealt with wounds at the same day with exposure （OR=0.11, 95%C1：0.01 ~ 0.90）. Meanwhile, disinfection or washing plus disinfection were effective measures, as compared with those untreated patients, their OR was 0.28 （95%C1：0.10 ~ 0.76） and 0.33（95%C1： 0.13- 0.80）, respectively. Conclusion Exposure degree, exposure location, number of exposure location, blood in wounds, wound treatment, method of wound treatment and time of dealing with wounds are the significant factors associated with rabies invasion. The results suggest that wounds should be dis- infected immediately in medical institutions after exposure to rabies.