132例手术切口感染患者临床特征及干预效果分析

Clinical characteristics and prognosis of 132 patients with surgical site infection

目的手术切口感染是一类常见的医院获得性伤口,文章旨在了解其临床特征与干预效果,为采取针对措施提供依据。方法纳入2016年1月至2018年12月在东部战区总医院门诊部伤口护理中心就诊并符合手术切口感染诊断标准的伤口患者132例,局部采用纳米银敷料并结合红光和红外线辅助治疗,全身给予个体化营养食谱和活动处方及淋浴清洗全身皮肤,隔日1次至愈合或2个月。观察指标:人口学资料和伤口特征资料;干预后14 d面积、深度变化;干预前后细菌阳性率及2个月的治愈率和愈合时间,进行分类分析、比较。结果 132例切口感染患者中符合浅层和深层手术切口感染标准者分别占52.27%和47.73%,平均年龄(48.33±16.90)岁,浅层和深层手术切口感染组性别、平均年龄相近(P>0.05)。所有患者切口周围皮肤污秽。切口感染发生时间(19.82±5.64)d,中位发生时间20 d,深层切口感染的发生时间与持续时间均长于浅层(P<0.05)。伤口面积两者差异无统计学意义(P>0.05),伤口深度深层均大于浅层SSI(P<0.05),细菌培养阳性率高于浅层SSI组(79.31%vs 59.46%,P<0.05)。治疗后14 d两者面积、深度均有明显缩小(P<0.05),细菌阳性率明显下降(P<0.05),干预2个月的浅层SSI组治愈率高于深层SSI组(84.06%vs 66.67%,P<0.05),愈合时间较深层切口感染组明显缩短[(35.46±11.12)d vs(41.08±11.33)d,P<0.05]。Logistic回归分析与愈合相关的因素,发现初诊细菌培养阴性能提高愈合概率(OR=0.190),长期使用抗生素并不能促进愈合(OR=0.343)。结论浅层和深层切口感染是切口感染的常见类型,性别、年龄相仿,伤口周围皮肤污秽有可能对SSI发生发展发挥作用,需要关注。局部结合全身干预措施能有效提高浅层和深层切口感染的愈合效果。细菌培养阴性和适当使用抗生素能提高伤口愈合的概率。

Objective Surgical site infection(SSI)is a type of common hospital-acquired wounds. The purpose of this study is to understand its clinical characteristics and prognosis in order to provide evidence for taking appropriate measures. Methods 132 wound patients who met the diagnostic criteria of surgical site infection in the wound care center in recent 3 years were enrolled. The patients were treated locally with nanosilver dressing combined with red light and infrared ray. Individualized nutritional recipes and activity prescriptions were given, and the skin was showered every other day to heal or last 2 months.Observation indicators: demographics and wound characteristics;changes of area and depth after14 days intervention;the posi-tive rate of bacteria before and after the intervention, and healing rate and healing time of 2 months were analyzed and compared. Results A total of 132 cases of SSI(52.27% superficial and 47.73% deep) was identified. The average age was 48.33±16.90 years. The average age and gender of the two groups were similar(P>0.05).Peri-wound skin is contaminated in all cases. The mean onset time of SSIs was 19.82±5.64 days, and the median onset time was 20 days. The onset time and duration of deep SSIs were longer than that of superficial SSIs(P<0.05). There was no significant difference between deep and superficial SSIs in a wound area(P>0.05), and the depth of deep SSIs was deeper than that of superficial SSIs(P<0.05).The positive rate of bacterial culture inthe deep SSI group(79.31%) was higher than that of the superficial SSI group(59.46%)(P<0.05). After 14 days treatment, the area was smaller, the depth was lower(P<0.05), and the positive rate of bacteria was significantly decreased in the two groups(P<0.05). The healing rate ofsuperficial SSI group(84.06%) was higher than that of deep SSI group(66.67%)(P<0.05) in two months, and the healing time of superficial SSI group was significantly shortened(35.46<11.12 days vs 41.08<11.33 days, P<0.05). Logistic regression analysis showed that negative bacterial culture before intervention increased the healing index(OR=0.190). Long-term use of antibiotics did not promote healing(OR=0.343). Conclusion Superficial and deep SSIs are common types of SSIs. Gender and age are similar, and skin contamination may play a role in the development of SSI,which needs attention. Local and systemic interventions can effectively improve wound healing. Negative bacterial culture and proper use of antibiotics can improve the healingprobability.