髋关节置换术后医院感染患者下肢微循环与微生物学检测结果研究

Microcirculation of lower limbs and microbiological detection of patients with nosocomial infection after hip replacement surgery

目的观察髋关节置换术后医院感染患者下肢微循环与微生物学检测结果,以为髋关节置换术后医院感染的预防控制与诊治提供依据。方法选取2015年1月-2016年7月医院诊治24例髋关节置换术后医院感染患者为观察组,同时选取24例髋关节置换术后未发生感染患者为对照组,然后检测及比较两组的下肢微循环指标,并比较不同感染部位患者的下肢微循环指标,同时检测及比较观察组患者中的病原菌情况。结果观察组足甲襞微循环加权积分襻周积分、管襻形态积分及总积分分别为(1.10±0.12)、(1.35±0.14)及(2.93±0.21),其显著地高于对照组(0.59±0.05)、(0.80±0.07)及(1.87±0.13),其他足甲襞微循环指标均低于对照组,手术部位感染患者足甲襞微循环指标差于其他部位感染者,24例感染患者共检出39株病原菌,革兰阳性菌所占比例明显高于革兰阴性菌,差异均有统计学意义(P<0.05)。结论髋关节置换术后医院感染患者下肢微循环处于较差的状态,而革兰阳性菌在此类患者的检出率相对较高,应给予充分的重视与干预。

OBJECTIVE To observe the microcirculation of lower limbs and microbiological detection of patients with nosocomial infection after hip replacement so as to provide guidance for prevention and control of the nosocomial infection after hip replacement.METHODS From Jan 2015 to Jul 2016,totally 24 patients who underwent the hip replacement and had the postoperative nosocomial infection were chosen as the observation group,meanwhile,24 patients who underwent the hip replacement but did not have postoperative infection were set as the control group.The indexes of microcirculation of lower limbs were detected and compared between the two groups of patients,the indexes of microcirculation of lower limbs were also compared among the patients with different sites of infection,and the distribution of pathogens was observed and compared among the patients in the observation group.RESULTS The foot-nail fold microcirculation weighted integral loop week integral of the observation group was（1.10±0.12）,significantly higher than（0.59±0.05）of the control group;the loop morphology integral of the observation group was（1.35±0.14）,significantly higher than（0.80±0.07）of the control group;the total integral of the observation group was（2.93±0.21）,significantly higher than（1.87±0.13）of the control group;other foot-nail fold microcirculation indexes of the observation group were better than those of the control group;the foot-nail fold microcirculation indexes of the patients with surgical site infection were worse than those of the patients with other sites of infection.A total of 39 strains of pathogens were isolated from 24 patients with infection,the proportion of the gram-positive bacteria was significantly higher than that of the gram-negative bacteria,and there was significant difference（P〈0.05）.CONCLUSIONThe patients with nosocomial infection are in a poor state of microcirculation of lower limbs after the hip replacement,however,the isolation rate of gram-positive bacteria is relatively high in this group of patients,to which great attention should be paid.