创伤患者手术切口感染及预防控制

Risk factors for surgical incision infections in trauma patients and prevention and control

目的：探讨外科创伤患者手术切口感染相关因素及防治策略，为有效防控医院感染提供依据。方法调查医院2012年1月－2013年12月425例外科创伤患者资料，分析患者年龄、性别、切口类型、手术时间、住院时间、抗菌药物应用等因素对切口感染的影响，采用 SPSS 19．0软件进行统计分析。结果425例患者术后切口感染31例，感染率7．29％；年龄6～14、15～60、＞60岁的感染率分别为5．26％、6．59％、14．29％；Ⅰ、Ⅱ、Ⅲ类手术切口感染率分别为3．33％、7．33％和13．70％；手术时间＜120 min与≥120 min的感染率分别为4．18％与13．77％，住院时间≤7、8～15、≥16 d的感染率分别为3．32％、9．65％、17．14％，差异均有统计学意义（ P＜0．05）；抗菌药物使用率达100．00％；感染切口共分离出病原菌43株，以革兰阴性菌为主，占51．16％。结论外科创伤手术切口感染的风险较高，患者年龄、切口类型、手术时间、住院时间是切口感染的主要影响因素，感染病原菌以革兰阴性菌为主；应采取针对性措施，才能有效预防和控制手术部位感染。

OBJECTIVE To explore the related factors for surgical incision infections in trauma patients of surgery department and put forward prevention countermeasures so as to provide guidance for effective control of nosoco‐mial infections .METHODS The clinical data of 425 patients with surgical trauma who were treated in the hospital from Jan 2012 to Dec 2013 were investigated ,then the influencing factors for the surgical incision infections ,in‐cluding the age ,gender ,type of incision ,operation duration ,and use of antibiotics ,were observed ,and the sta‐tistical analysis was performed with the use of SPSS 19 .0 software .RESULTS The surgical incision infections oc‐curred in 31 of 425 patients with the infection rate of 7 .29% ;the incidence of infections was 5 .26% in the patients aged between 6 and 16 years old ,6 .59% in the patients aged between 15 and 60 years old ,14 .29% in the patients aged more than 60 years old;the incidence of infections was 3 .33% in the patients undergoing type Ⅰ incision surgery ,7 .33% in the patients undergoing the type Ⅱ incision surgery ,13 .70% in the patients undergoing the type Ⅲ incision surgery ;the incidence of infections was 4 .18% in the patients with operation duration less than 120 min ,13 .77% in the patients with the operation duration no less than 120 min;the incidence of infections was 3 .32% in the patients with the hospitalization duration no more than 7 days ,9 .65% in the patients with the hos‐pitalization duration varying from 7 to 16 days ,17 .14% in the patients with the hospitalization duration no less than 16 days ,there were statistically significant differences （P〈 0 .05） .The utilization rate of antibiotics was 100 .00% .Totally 43 strains of pathogens have been isolated from the patients with incision infections ,among which the gram‐negative bacteria accounted for 51 .16% .CONCLUSION The patients with surgical trauma are at high risk of surgical incision infections ;the age ,type of incision ,operation duration ,and hospitalization duration are the major influencing factors for the incision infections .The gram‐negative bacteria are the predominant patho‐gens causing infections .It is necessary to take targeted measures so as to effectively prevent and control surgical site infections .