骨科Ⅰ类(清洁)切口早期感染相关危险因素的前瞻性研究

Prospective study of risk factors analysis about orthopaedic sterile incision with early infection

目的研究骨科Ⅰ类切口出现术后早期切口感染的相关危险因素。方法前瞻性收集河北省衡水市人民医院骨科中心2020年1月1日至6月30日间收治的Ⅰ类切口骨科手术患者且符合纳入排除标准的患者779例,随访观察其术后早期感染发生情况,对可能影响术后切口感染的27个指标[患者因素:年龄、性别、职业、城市或农村、BMⅠ、吸烟史、过敏史、手术史、术前合并症、致伤原因;手术相关因素:受伤至手术时间、麻醉时间、麻醉方式、术中有创操作(桡动脉测压)、手术持续时间、术中出血量、术中输血量、术中晶体输入量、术中胶体输入量、术中体温、ASA分级;术前实验室检查:血常规、肝肾功能、血凝分析]进行单因素筛选和logistic回归分析,筛选出骨科术后早期切口感染的独立危险因素。结果本研究共759例患者获得完整随访,随访率97.4%。随访时间(6.7±0.9)d,其中男420例,女339例,平均年龄(41±22)岁。随访期间共24例患者出现手术切口感染,其中浅感染22例,深感染2例,感染率为3.16%,且以金黄色葡萄球菌感染为主(55.6%)。单因素分析中两组患者的麻醉方式、白细胞、中性粒细胞计数、血清白蛋白差异有统计学意义(P<0.05),logistic回归分析得出术前低血清白蛋白(P<0.05)为术后早期切口感染的独立危险因素,骨科无菌切口早期感染概率P=1/1+e-(7.882-0.119ALB)。血清白蛋白≤35 g/L时,感染率高达23.43%。结论骨科患者术前低血清白蛋白是Ⅰ类手术切早期感染独立危险因素,术前提高患者血清白蛋白有利于预防切口早期感染。

Objective To prospectively study postoperative early infection of orthopaedic sterile incision so as to identify risk factors.Methods To investigate and follow up the incidence of early postoperative infection in patients with type I incision admitted to the Orthopedic Center of our hospital from January 1 to June 30,2020.The 27 indicators that may affect postoperative incision infection were age,gender,occupation,urban or rural area,BMI,smoking history,allergic history,operation history,preoperative complications,and cause of injury The time from injury to operation,anesthesia time,anesthesia method,invasive operation(radial artery manometry),operation duration,intraoperative blood loss,intraoperative blood transfusion,intraoperative lens input,intraoperative colloid input,intraoperative body temperature,preoperative antibiotics,ASA classification;preoperative laboratory examination:routine blood test,liver and kidney function,hemagglutination analysis,univariate screening and logistic regression were performed Objective to analyze and screen the independent risk factors of early postoperative incision infection.Results A total of 759 patients were followed up,the follow-up rate was 97.4%.There were 420 males and 339 females with an average age of(41±22)years.During the follow-up period,24 patients had surgical incision infection,the infection rate was 3.16%,and Staphylococcus aureus infection was the main infection(55.6%).In univariate analysis,there were significant differences in anesthesia mode,white blood cell(WBC),neutrophil count(neut)and serum albumin(ALB)between the two groups(P<0.05).Logistic regression model analysis indicated that preoperative ALB(P<0.05)were independent risk factors for early postoperative infection of incisional Wound,The probability of infection in orthopedic sterile early incision P=1/1+e-(7.882-0.119ALB).ALB≤35 g/L,the infection rate as high as 23.43%.Conclusion Highlighting preoperative ALB levels in patients has an important role in improving the prevention of early infection in orthopedic sterile incision.