口腔颌面外科患者术后感染因素分析研究

Factorial analysis and research on postoperative infection of oral and maxillofacial surgery

目的分析口腔颌面外科患者手术感染发生的高危因素,并利用随机对照试验比较两种用药策略的疗效,为临床合理使用抗菌药物提供依据。方法收集医院2012年5月-2013年4月收治的2 818例口腔颌面部外科手术患者资料,对术后感染患者进行调查研究,并将66例感染患者的初始治疗用药方案随机分为单用广谱抗菌药物组、联合用药组,每组各33例,主要观察终点为局部感染控制,体温、白细胞及中性粒细胞等恢复正常。结果 2 818例口腔颌面外科手术患者发生感染66例,感染率为2.34%,其中口腔颌面部肿瘤手术感染患者55例占83.33%;深部切口感染最高占77.27%,其次为下呼吸道、表浅切口和上呼吸道感染,分别占16.67%、4.55%和1.52%;年龄≥55岁、手术切口类型、特殊手术操作的术后感染患者相关因素比较,差异有统计学意义(P<0.05);单用广谱抗菌药物组平均治疗(7.30±0.89)d,联合用药组平均治疗(5.30±0.45)d,经kaplanmeier分析,差异有统计学意义(P<0.05);治疗中未发生抗菌药物相关的不良反应。结论口腔颌面部肿瘤手术、高龄、Ⅲ类手术切口、特殊手术操作类型患者发生感染风险较大;针对手术感染病例,早期联用奥硝唑,可显著缩短感染治疗时间。

OBJECTIVE To analyze the high risk factors for surgical infections in patients after oral and maxillofacial surgery ,and conduct randomized controlled trials to compare the efficacy of two treatment strategies ,so as to provide the basis for clinical rational use of antimicrobial drugs .METHODS The clinical data were collected from 2818 cases of oral and maxillofacial surgery from May 2012 to Apr .2013 .Patients with postoperative infections （n=66） were investigated ,and the initial treatment regimens for the 66 patients were randomly divided into the group of single use of broad‐spectrum antibiotics and the group of combined broad‐spectrum antibiotics ,with 33 cases in each group .The primary endpoint included the local infection control ,body temperature ,white blood cells and neutrophils returned to normal .RESULTS The incidence of infection after oral and maxillofacial surgery was 2 .34% as there were 66 cases of infection in the 2818 patients . There were 55 cases of tumor surgical infection ,accounting for 83 .3% ,infection in deep cuts accounting for 77 .27% ,and infection in lower respiratory tract ,shallow incision ,and upper respiratory infection ,accounting for 16 .67% ,4 .55% and 1 .52% .There were statistically significant differences in comparison of related factors for postoperative infection ,including age ≥55 years ,types of surgical incision and special surgical operation （P〈 0 .5） .The average treatment duration was （7 .30 ± 0 .89） d in the group of single use of broad‐spectrum antibiotics and （5 .30 ± 0 .45） d in the group of combined broad‐spectrum antibiotics , with statistical significance by Kaplan‐meier analysis （ P〈 0 .05 ） . No antimicrobial treatment‐related adverse events occurred .CONCLUSION Patients with oral and maxillofacial tumor surgery ,advanced age ,class Ⅲ incision ,and special surgical operation were at a higher risk for postoperative in‐fection .For the surgical infections ,early combined use of ornidazole could significantly shorten the treatment time .