四肢开放性骨折患者医院感染的影响因素与预防

Influencing factors and countermeasures of nosocomial infections in open limb fractures

目的分析四肢开放性骨折患者医院感染的影响因素,并在此基础上提出科学高效的解决策略,从而减少患者医院感染率、提高治疗效果、改善预后。方法选取2012年9月-2014年9月医院收治的四肢开放性骨折患者1 135例为研究对象,所有患者入院后均接受清创术治疗,采集患者伤口脓液或分泌物进行细菌培养及鉴定,详细记录、分析患者临床资料,数据均采用SPSS 18.0统计软件进行处理。结果 1 135例四肢开放性骨折患者发生医院感染268例,感染率为23.61%;采集医院感染患者标本392份,检出病原菌共237株,检出率为60.46%;其中革兰阴性菌135株占56.96%,革兰阳性菌102株占43.04%;创口遗留空腔、使用骨折内固定、住院时间长的四肢开放性骨折患者感染率较高,且差异有统计学意义(P<0.05),患者的性别和年龄对患者感染率无明显影响,差异无统计学意义;创口留空腔、骨折内固定、住院时间延长均为四肢开放性骨折患者医院感染的独立危险因素。结论采取正确合适的手术方式、使用适宜的固定方式、缩短住院时间均可以降低四肢开放性骨折患者医院感染的发生、提高治疗效果。

OBJECTIVE To analyze the affecting on this basis factors on the limbs of nosocomial infections in open limb fractures and propose ascientific and efficient solution strategy,thereby to reduce the incidence of nosocomial infections,and to improve treatment and prognosis.METHODS A total of 268 cases of patients with open limb fractures treated in our hospital from Sep.2012 to Sep.2014 were selected as study objects.All patients received debridement operation.Bacteria identification and detection were carried out by collecting pus or secretions of patients＇ wound.Clinical data of the patients were recorded in detail and analyzed.The results were statistically analyzed by software SPSS18.0.RESULTS Among the 1135 cases of patients,268 cases underwent nosocomial infections with the incidence of 23.61%.A total of 392 samples were collected,and 237 strains pathogens were isolated with a detection rate of 60.46%,among which there were 135 trains of gram-negative bacteria accounting for56.96%,102 trains of gram-positive bacteria accounting for 43.04%,Patients with limb open fracture wounds left cavity,using internal fracture fixation,prologning hospitalization had significently higher infection rate（P〈0.05）.Patient＇s gender and age had no significant effect on the incidence of infections.Blank wound cavity,fracture fixation and prolonged hospitalization were independent risk factors for hospital patients with open fractures of limbs infection.CONCLUSION Right and proper surgical approach,suitable and fixed way and shorter hospital stays can reduce the incidence of nosocomial infections of patients with open limb fracture,and improve the therapeutic effect.