骨科术后切口感染的临床特征与危险因素分析

Clinical characteristics and risk factors of incision infection after orthopedic surgery

目的:探讨骨科患者术后切口感染的临床特征及危险因素。方法:参照《医院感染诊断标准(试行)》,纳入我院2013年1月-2017年3月在我院行骨科手术的218例(切口感染患者为36例,未发生切口感染患者182例)患者病例资料,准确诊断切口感染,收集纳入研究患者的人口统计学资料及临床相关数据,分析骨科术后切口感染的临床特征,确定危险因素,并采用回归分析的方法探讨切口感染的危险因素。结果:按照是否发生切口感染分为两组,切口感染患者为36例,未发生切口感染患者182例,切口感染组的糖尿病病史人数、复合伤例数、平均年龄、术中出血量、下肢或躯干部位手术、急诊手术例数、切口长度、手术时间等指标均明显高于/多于未发生切口感染组,两组比较差异有统计学意义(P<0.05);通过回归分析结果显示,切口感染与手术时间相关性不大,密切相关的因素有切口类型、手术类型、术中出血。结论:手术切口感染与患者的骨科创伤情况、手术难易等因素具有相关性,值得注意的是我们发现与手术时间相关性不大,若在手术过程中严格无菌操作,与手术操作时间的长短并未成为切口感染的直接危险因素,但是不可否认随着时间的延长,手术操作细节较多,感染的可能性仍有增高的可能,尤其对于超长时间的手术,应当引起重视,对可能发生的感染因素进行认真的排查,以降低手术切口感染的风险。

Objective: To investigate the clinical characteristics and risk factors of incision infection in orthopedic patients. Methods: According to Diagnostic criteria of nosocomial infection(Trial), 218 cases of orthopedic surgery in our hospital from January 2013 to March 2017(36 cases of incision infection and 182 cases of non-incision infection) were included, incision infection was accurately diagnosed, collection of demographic data and clinical data of patients was included in the study, analysis of clinical features of incision infection after orthopedic surgery was made to determine the risk factors, and regression analysis of the risk factors for incision infection was made. Results: According to whether there was incision infection, the data was divided into two groups, there were 36 cases with incision infection, 182 cases without incision infection, the number of diabetes mellitus history, the number of combined wounds, the average age, intraoperative blood loss, the number of trunk operation, emergency operation, incision length and operative time of those who had incision infection were significantly higher than those of who had no incision infection(P<0.05). The results of regression analysis showed that incision infection and operation time was not relevant, the closely related factors included incision type, type of surgery, intraoperative bleeding. Conclusion: There was a correlation between surgical incision infection and patients' orthopedic trauma and the difficulty of operation. It was noteworthy that we found little correlation with the operation time. If the operation was strictly aseptic and the operation time had not become a direct risk factor for wound infection, but it was undeniable that with the extension of time and more details of surgical procedures, the possibility of infection was still likely to increase, especially for ultra-long period of surgery, which should pay attention to the possible occurring infection factors in making careful investigation to reduce the risk of surgical incision infection.