不同消毒方式对老年骨科手术切口感染的影响

Effect of Different Disinfection Methods on Incision Infection in Elderly Orthopaedic Surgery

目的对比四种消毒方式对老年骨科手术切口感染的影响。方法选取2016年1月至2018年11月盐城大丰同仁医院收治的244例老年骨科手术患者,依据随机数字表法分为4组,每组61例。A组采用葡萄糖酸氯己定消毒,B组采用聚维酮碘消毒,C组采用聚维酮碘联合含碘手术薄膜消毒,D组采用醋酸氯己定聚维酮碘复方消毒液联合含碘手术薄膜消毒,对比四种消毒方式的效果。结果C组和D组的甲级愈合率、抑菌持续时间显著高于A组和B组,手术愈合时间、感染率显著低于A组和B组,差异具有统计学意义(P<0.05)。4组患者消毒10 min后的菌落数较消毒前降低(P<0.05),手术结束后菌落数比较B组>A组>C组>D组(P<0.05)。感染患者送检标本共检测出病原菌44株,其中革兰氏阴性菌24株(54.5%),革兰氏阳性菌16株(36.4%)。结论醋酸氯己定聚维酮碘复方消毒液联合含碘手术薄膜能够有效降低行骨科手术老年患者术后切口感染率,促进术后恢复,提高生活质量,安全性佳。

Objective To compare the effects of 4 disinfection methods on incision infection in elderly orthopaedic surgery patients.Methods From January 2016 to November 2018,A total of 244 elderly patients admitted to Yancheng Dafeng Tongren Hospital for orthopedic surgery were divided into 4 groups according to a random number table method,with 61 cases in each group.Group A was disinfected with chlorhexidine gluconate,group B with povidone iodine,group C with povidone iodine combined with iodine-containing surgical film,group D with chlorhexidine acetate and povidone iodine compound disinfectant combined with iodine-containing surgical film.The clinical effects with 4 disinfection methods were compared.Results The healing rate and bacteriostasis duration of groups C and D were significantly higher than those of groups A and B,and the healing time and infection rate of operation were significantly lower than those of groups A and B(P<0.05).The numbers of colonies in 4 groups after 10 min of disinfection were lower than those before disinfection(P<0.05).After operation,the number of colonies in group B was>group A>group C>group D(P<0.05).The samples of infected patients were examined and 44 strains of protozoa were detected with 24 strains of Gram-negative bacteria(54.5%),16 strains of Gram-positive bacteria(36.4%).Conclusion The combination of chlorhexidine acetate and povidone iodine compound disinfectant and iodine-containing surgical film can effectively reduce the wound infection rate of elderly patients undergoing orthopaedic surgery,promote the recovery and improve the quality of life,has a better safety.