开放性骨折患者感染的高危因素调查研究

Risk factors for infections in patients with open fractures

目的调查分析开放性骨折患者感染的高危因素,为该类患者预防感染提供参考。方法对医院2009年11月-2010年11月收治的324例开放性骨折患者的诊治资料进行回顾性分析,将上述患者按照治疗期间是否感染,将其分为感染组68例,非感染组256例;对两组患者的一般资料、疾病情况、医疗差异等进行分析,探讨开放性骨折患者感染的高危因素。结果经对比分析,感染组与非感染组患者感染率分别为年龄≥60岁者85.3%、55.9%,体重指数>30者42.6%、21.1%,并发软组织伤>3处者91.4%、58.6%,原发糖尿病25.0%、10.1%,创伤发生至医院清创时间≥5 h者86.8%、30.1,手术时间(5.7±1.5)h、(3.5±1.9)h,内置金属物95.6%、21.1%,术后住院时间(25.2±2.4)d、(31.8±3.1)d,组间比较差异有统计学意义(P<0.05)。结论开放性骨折患者感染的高危因素有:高龄、并发多处软组织损伤、肥胖、并发糖尿病、手术暴露时间长、内置金属材料、术后住院时间长,临床治疗护理应综合考虑患者治疗方案等因素,采用先进、确切有效的护理措施,加强围手术期的医院感染控制管理,降低开放性骨折患者医院感染的发生率。

OBJECTIVE To investigate and analyze the risk factors for infections in patients with open fractures so as to provide bases for the prevention of infections.METHODS The clinical data of 324 patients with open fractures who received treatment from Nov 2009 to Nov 2010 were retrospectively analyzed,according to the infection condition during the treatment,those subjects were divided into the infection group（68 cases） and non-infection group（256 cases）.The general status,the diseases and the medical differences of the two groups were analyzed.The risk factors for infections in patients with open fractures were explored.RESULTS The comparative analysis showed that the infection rates of the infection group and non-infection group respectively were 85.3% and 55.9% of the patients at the age of 60 years or older,42.6% and 21.1% of the patients with body mass index more than 30,91.4% and 58.6% of the patients with soft tissue injuries more than 3 sites,25.0% and 10.1% of the patients with primary diabetes mellitus,86.8% and 30.1% of the patients with the duration from the occurrence to wound debridement more than 5h,95.6% and 21.1% of the patients with operation duration of（5.7±1.5）h and（3.5±1.9）h and the postoperative hospital stay（25.2±2.4）d and（31.8±3.1）d,with built-in metal materials,the differences were statistically significant（P〈0.05）.CONCLUSION The risk factors for infections in patients with open fractures include the senior age,concurrent multiple soft tissue injuries,obesity,diabetes mellitus,surgical exposure for a long time,built-in metal materials,and long hospital stay;it should consider the patients,treatment program and other factors as the clinical treatment and nursing are performed.The advanced,precise and effective measures to strengthen the control of nosocomial infections during perioperative period should be adopted so as to reduce the incidence of nosocomial infections in patients with open fractures.