下肢开放骨折患者术后感染病原菌与负压封闭引流治疗分析

Distribution of pathogens causing postoperative infections in lower limb open fracture patients and effect of vacuum sealing drainage

目的研究分析下肢开放骨折患者术后感染病原菌分布及负压封闭引流的效果,为临床治疗提供参考。方法选取医院2009年6月-2014年6月诊治的70例下肢开放骨折术后感染患者设为感染组,以医院同期70名健康体检者为对照组,下肢骨折患者术后未感染300例为未感染组,分析感染患者的病原菌分布,对比3组受试人员血清中细胞间黏附因子1、可溶性血管细胞黏附因子1和核因子Κb(NFκB)蛋白水平变化,并探讨负压封闭引流对感染的治疗效果。结果 70例感染患者中共分离病原菌70株,其中革兰阳性菌34株占48.6%,以酿脓链球菌、肺炎链球菌和金黄色葡萄球菌为主;革兰阴性菌36株占51.4%,以产气肠杆菌、铜绿假单胞菌和大肠埃希菌为主;感染患者血清中细胞间黏附因子1和可溶性血管细胞黏附因子1水平明显低于对照组和未感染组患者,而NFκB蛋白明显升高,且差异有统计学意义(P<0.05);负压封闭引流组患者的治疗效果明显优于非负压引流术患者,差异有统计学意义(P<0.05)。结论下肢开放骨折患者术后容易并发病原菌感染,负压封闭引流对感染患者具有较好的治疗效果。

OBJECTIVE To investigate the distribution of pathogens causing postoperative infections in lower limb open fracture patients and observe the effect of vacuum sealing drainage so as to provide guidance for clinical treatment.METHODS A total of 70 lower limb open fracture patients complicated with postoperative infections who were treated in the hospital from Jun 2009 to Jun 2014 were enrolled in the study and assigned as the infection group;meanwhile,70 healthy people who received the physical examination were set as the control group,and300 lower limb fracture patients without postoperative infections were chosen as the non-infection group.The distribution of pathogens causing the infections was analyzed,the levels of serum intercellular adhesion molecule-1,soluble vascular cell adhesion molecule-1,and nuclear factorΚb（NFκB）protein were observed and compared among the three groups of subjects,and the effect of the vacuum sealing drainage on treatment of infections was explored.RESULTS A total of 70 strains of pathogens were isolated from the 70 patients with infections,including34（48.6%）strains of gram-positive bacteria and 36（51.4%）strains of gram-negative bacteria;the Streptococcus pyogenes,Streptococcus pneumoniae,and Staphylococcus aureus were dominant among the gram-positive bacteria;the Enterobacter aerogenes,Pseudomonas aeruginosa,and Escherichia coli were the predominant species of gram-negative bacteria.The levels of serum intercellular adhesion molecule-1and soluble vascular cell adhesion molecule-1were significantly lower in the infection group than in the control group and the non-infection group,while the NFκB level was significantly elevated（P〈0.05）.The curative effect of the patients who received the vacuum sealing drainage was significantly better than that of the patients who did not（P〈0.05）.CONCLUSION The lower limb open fracture patients tend to be complicated with postoperative infections.The vacuum sealing drainage can achieve significant effect on treatment of the patients with infections.