骨科无菌手术切口感染相关因素的多元Logistic回归分析及防控措施

Multivariate Logistic Regression Analysis and Prevention and Control Measure of Related Factors of Incision Infection in Aseptic Surgery in Department of Orthopedics

探讨本院骨科无菌手术术后切口感染的危险因素。选取2013年1月至2017年6月本院行骨科无菌手术的患者1826例进行分析，记录患者切口感染的发生率、自身因素和医源性因素，观察患者自身因素和医源性因素与切口感染发生的相关性。1826例患者发生切口感染44例，切口感染发生率2．41％。单因素分析显示，年龄、性别、糖尿病、冠心病、慢阻肺、体质量指数、手术性质、手术时间、层流手术室、接台手术、术中出血量、预防性抗菌药物、住院时间、术前合并其他部位感染、抗菌药物、入住ICU、营养不良、围手术期高血糖、侵袭性操作、备皮方式、术后引流、参观人员、切口分类、术前白细胞均是影响术后切口感染发生的因素（p〈0．05），高血压、高脂血症、吸烟、饮酒、手术部位、切口长度、手术方式、激素应用、全麻、手术季节不会影响术后切口感染发生（p〉0．05）。多因素Logistic分析显示年龄、手术时间≥2h、接台手术、住院时间≥15d、抗菌药物〉12种是本院骨科无菌手术术后切口感染的独立危险因素（p〈0.05），层流手术室是本院骨科无菌术后切口感染的保护性因素（p〈0．05）。骨科无菌手术切口感染受多种因素影响，掌握发生切口感染的危险因素，进行针对性的防控有助于降低骨科无菌手术切口感染发生率。

To explore the risk factors of postoperative incision infection in orthopaedic surgery, 1 826 patients in orthopedic aseptic operation from January 2013 to June 2017 were selected. The incidence of incision infection, internal and iatrogenic factors were recorded, and the patient＇s internal and iatrogenic factors and their correlation with incision infection were observed. There were 44 cases of incision infection in, 1 826 patients, which meant the incidence of incisional infection was 2.41%. Single factor analysis showed that age, gender, diabetes, coronary heart disease, COPD, body mass index, operation characteristics, operation time, laminar flow operating room, consecutive operation, intraoperative blood loss, prophylactic antimicrobial agents, the length of hospital stay, and preoperative merge infection, antimicrobial agents, ICU admission, malnutrition, perioperative hyperglycemia, invasive operation, the skin mode, postoperative drainage, visitors, cut classification, preoperative white blood cells were the influencing factors of postoperative incision infection （p〈0.05）. While, hypertension, hyperlipidemia,smoking, drinking, surgical site, incision length, operation method, hormone appllcation, general anesmesla, surgical season could not affect postoperative incision infection （p 〉0.05）. Multiariable Logistic analysis showed that the age, operation time （≥ 2 h）, consecutive operation, hospitalization time （≥1 5 d）, antimicrobial drugs （≥ 2 kinds） were independent risk factors of our hospital orthopedic aseptic operation for postoperative incision infection （p〈0.05）; laminar flow operating room was the protective factor of postoperative incision infection in our hospital orthopedic aseptic （/9 〈0.05）. Orthopedic aseptic incision infection is affected by many factors, therefore mastering risk factors of the incision infection, the corresponding prevention and control could help reduce the incidence of postoperative incision infection after orthopedic aseptic.