手部软组织缺损皮瓣修复术后切口感染临床特点及影响因素分析

Clinical characteristics and influencing factors of incision infection after hand soft tissue defect flap repair

目的探讨手部软组织缺损皮瓣修复术后切口感染临床特点及相关影响因素。方法回顾性分析2017年1月至2019年9月期间在本院接受手部软组织缺损皮瓣修复术的195例患者临床资料,依据术后有无感染将入选者分为感染组(18例)与未感染组(177例)。记录一般资料,对手部软组织缺损皮瓣修复术后切口感染的相关因素给予分析。结果本研究对18例感染者切口感染病原菌进行研究,共检出43株病原菌,其中革兰阳性菌占比较高为67.44%,革兰阴性菌占比为32.56%;感染组患者创面污染程度(重度)、伤后就诊时间(≥6 h)、合并基础性疾病、年龄(≥50岁)、术后未使用抗菌药物、手术时间(≥2 h)占比均高于未感染组,差异均有统计学意义(均P<0.05);经logistic回归分析发现,创面污染程度(重度)、伤后就诊时间(≥6 h)、合并基础性疾病、年龄(≥50岁)、术后未使用抗菌药物、手术时间(≥2 h)为导致手部软组织缺损皮瓣修复术患者术后感染的独立危险因素(均OR>1,均P<0.05)。结论创面重度污染、伤后就诊时间(≥6 h)、合并基础性疾病、年龄(≥50岁)、术后未使用抗菌药物、手术时间(≥2 h)等均是造成手部软组织缺损皮瓣修复术患者术后感染的影响因素,临床可通过对术后患者辅助使用抗菌药物等方式,以降低术后感染的风险。

Objective To investigate the clinical characteristics and related factors of incision infection after soft tissue defect flap repair.Methods The clinical data of 195 patients who received hand soft tissue defect flap repair in our hospital from January,2017 to September,2019 were retrospectively analyzed.According to whether they had postoperative infection or not,the patients were divided into an infection group(18 cases)and an uninfected group(177 cases).The relative factors of incision infection after soft tissue defect flap repair were analyzed.Results The pathogens of incision infection were detected in the 18 cases.In this study,43 strains of pathogenic bacteria were detected;of which,Gram-positive bacteria accounted for 67.44%,and Gram-negative bacteria 32.56%.The proportions of severe wound contamination,treatment≥6 h after injury,complication with basic diseases,≥50 years old,no antibiotics after surgery,and operation time≥2 h in the infection group were significantly higher than those in the non-infection group(all P<0.05).The results of logistic regression analysis showed that severe wound contamination,treatment≥6 h after injury,complication with basic diseases,≥50 years old,no antibiotics after surgery,and the operation time≥2 h were independent risk factors for postoperative infection in patients after hand soft tissue defect flap repair(all OR>1;all P<0.05).Conclusion Severe wound contamination,treatment≥6 h after injury,complication with basic diseases,≥50 years old,no antibiotics after surgery,and the operation time≥2 h are factors influencing postoperative infection in patients after hand soft tissue defect flap repair.The infection risk can be reduced postoperative antibiotics.