护理干预对胫腓骨开放骨折术后术区感染的多因素Logistic回归分析及临床处理

Multi-factor logistic regression analysis on nursing intervention for postoperative surgical site infection of open tibiofibula fracture and its clinical treatment

目的回顾性研究胫腓骨开放骨折术后术区感染发生的相关危险因素,并分析其临床处理策略以改善其预后。方法选择该院2012年1月‐2015年12月胫腓骨开放骨折患者628例,术后术区感染患者79例(观察组),感染率为12.58%,未发生感染患者549例(对照组)。评估感染患者相关危险因素,并进行多因素Logistic回归分析。结果患者年龄≥60岁、合并基础性疾病≥3种、IIIb型骨折分型、内固定方式、未术后引流、彻底清创、皮瓣覆盖创面和住院时间≥3周的感染率分别为20.59%、25.51%、47.73%、23.08%、15.38%、45.35%、23.31%及20.10%,均高于同组其他患者,比较差异有统计学意义(P<0.05);观察组患者受伤至手术时间和手术时间分别为(9.83±0.61)h和(3.70±0.41)h,均高于对照组,差异具有统计学意义(P<0.05)。结论年龄、合并基础疾病、骨折分型、固定方式、术后引流、清创是否彻底、受伤至手术时间、手术时间、住院时间均是胫腓骨开放骨折术后术区感染的相关危险因素。临床应积极采取有效的处理措施,以降低术区感染率,改善患者预后。

[Objective] To retrospectively study surgical site infection related risk factors of the open fracture of tibia and fibula after surgery, and to analyze the clinical treatment strategy in order to improve the prognosis, [Methods] A total of 628 patients with the open fracture of tibia and fibula admitted in the hospital from January 2012 to December 2015 were selected. Postoperative surgical site infection was found in 79 cases （the observation group）, the infection rate was 12.58%, the patients without infection was 549 cases （the control group）. The risk factors of infection patients were evaluated and multiple logistic regression analysis was performed. [Results] The infection rates of patients with the age ≥ 60 years old, with 3 or more than 3 kinds of basic diseases, type IIIB fracture and internal fixation, without postoperative drainage, with thorough debridement and skin flap to cover the wound and hospitalization time 〉 3 weeks were respectively 20.59%, 25.51%, 47.73%, 23.08%, 15.38%, 45.35%, 23.31% and 20.10%, which were higher than those of the patients in the same group, and the differences were statistically significant （P 〈0.05）. The time from injury to operation and the operation time of patients in observation group were （9.83-4-0.61） h and （3.70-4-0.41） h, which were higher than those in the control group, and the differences had statistical significance （P 〈0.05）. [Conclusion] The risk factors of postoperative infection of open fracture of tibia and fibula after surgery were the age, basic disease, fracture classification, fixation, postoperative drainage, thorough debridement or not, the time from injury to the operation, operation time, and hospitalization time. Effective measures should be taken actively in clinic to reduce the infection rate and improve the prognosis of patients.