老年患者骨科手术切口感染的危险因素分析

Analysis of the risk factors in surgical wound infection in elderly patients

目的探究老年患者骨科手术后切口的高危因素,并针对这些高危因素提出有效的防治措施。方法选择本院骨科2011年11月-2014年11月收治的900例老年骨科手术患者。收集患者的临床资料,主要包括临床基本信息、是否发生感染、感染部位细菌分型以及感染部位耐药菌试验等。对这些因素作单因素分析和多因素Logistic回归分析。结果病原菌主要以金黄色葡萄球菌和铜绿假单胞菌为主,分别占22.61%、16.52%。Logistic多因素回归分析可知,患者年龄≥65岁、住院时间≥2周、手术时间≥2 h、手术切口长度≥5 cm、有多个手术切口、患者本身有糖尿病或高血脂或高血压病史,均成为造成老年骨科手术患者术后切口感染的因素(P<0.05)。结论老年骨科患者的切口在受到多种因素的共同影响与作用下较易发生感染。为预防感染的发生,应减少对患者的手术时间、控制基础疾病、诊治过程中严格执行无菌理念、合理使用抗菌药物、做好病房环境的消毒工作。

Objective To explore the risk factors of postoperative incision in elderly patients,and to provide effective prevention and control measures for these high risk factors. Methods 900 elderly patients with surgical operation in the Department of Orthopedics from November 2011 to November 2014 were selected. To collect the clinical data of these patients,mainly including clinical basic information,whether there is infection,bacteria typing and resistance bacteria test on infection site,etc. Single factor analysis and multivariate Logistic regression analysis were performed to analyze the risk factors. Results The main pathogens were Staphylococcus aureus and Pseudomonas aeruginosa,which accounted for 22. 61% and 16. 52%,respectively.Multivariate Logistic regression analysis showed that age ≥65 years old,hospitalization time ≥2 weeks,the operation time ≥2h,the length of incision ≥5 cm,plurality of surgical incision,and diabetes,high cholesterol or hypertension were the surgery incision infection factors in senile patients after orthopedics operation（ P 〈 0. 05）. Conclusion The incision in the elderly patients with orthopedics disease is easy to be inffected by many factors. In order to prevent infection,we should reduce the operation time,control the basic diseases,perform the strict implementation of aseptic concept,rationally use antimicrobial agents,and do a good job in the disinfection of ward environment.