皮肤软组织扩张器置入术感染的病例对照研究

A case-control study on infection following skin and soft tissue expander implantation

目的分析影响患者皮肤扩张器置入术后感染的危险因素，为制订干预措施提供科学依据。方法采用自行设计的调查问卷，通过查阅病历结合电话询问获取相关资料，采用病例对照研究方法进行统计分析。结果共调查532例扩张器置入患者，其中发生术后感染22例，感染率为4．14％，病例组共纳入14例感染患者。单因素条件logistic回归分析结果显示，扩张器置入个数（OR=1．58，95％CI：1．20～2．32）、埋置部位（OR=1．75，95％CI：1．30～2．32）、患者居住环境（OR=1．87，95％CI：1．84～2．65）、是否常规消毒（OR=2．66，95％CI：1．76～4．32）差异均有统计学意义（均P〈0．05）。多因素条件logistic回归分析结果显示患者居住环境（OR=1．55，95％CI：1．15～2．25）、是否常规消毒（OR=3．66，95%CI：2．86～3．22）是进入回归方程的2个主要因素，均P〈0．01。结论患者居住环境以及是否常规消毒是影响患者皮肤软组织扩张器置入术后感染的主要危险因素，临床上应重点加强对围手术期患者及主要照顾者预防感染知识教育，建立患者出院后延续护理体系。

Objective To analyze the risk factors of postoperative infection in patients with skin and soft tissue expander （SSTE） implantation, and provide scientific evidence for making intervention strategies. Methods Questionnaires were made, relevant data were obtained through medical record reviewing and telephone inquiry, and case- control method was used to conduct statistical analysis. Results A total of 532 patients were with SSTE implantation, 22 （4.14%） of whom had infection, and 14 infected patients were included in this research. Univariate logistic regression analysis indicated that there were significant difference in the number of the embedded expanders （OR = 1.58,95%CI：1.20 - 2.32）, the implantation site（OR = 1.75,95%CI ： 1.30 - 2.32）, living circumstances of pa- tients（OR= I. 87,95%CI： 1.84- 2. 65）, and whether expanders were regularly disinfected（OR = 2. 66,95%CI： 1.76 - 4.32）（all P〈0.05）. Multivariate logistic regression analysis found that living circumstances of patients（OR = 1.55,95 % CI： 1.15 - 2.25） and whether expanders were regularly disinfected （OR = 3.66,95 % CI： 2.86 - 3.22） were two main factors entering the regression equation（both P〈0.01）. Conclusion Living circumstances of pa- tients and whether expanders are regularly disinfected are main risk factors of postoperative infection in patients with SSTE embedding. Knowledge education on preventing infection among patients and main caregivers should be strengthened,post-discharge continuous nursing system should be established.