多发性创伤骨折手术部位感染影响因素巢式病例对照研究

Nested case-control study on the influencing factors of surgical site infection in patients with multiple traumatic fractures

目的应用巢式病例对照研究模式分析多发性创伤骨折患者手术部位感染(SSI)的影响因素,为多发性创伤骨折患者SSI防治提供参考依据。方法以入院确诊多发性创伤骨折为起点、出院为终点,应用巢式病例对照研究方式,将2018年1月-2019年7月发生SSI的患者纳入SSI组,当队列内每出现1例SSI患者时,在该队列尚未出现SSI的患者中同步选取入院间隔时间<1周、骨折部位数量相近(±1个)、性别相同的患者,按1∶2比例匹配非SSI组。32例发生SSI患者纳入SSI组,按巢式病例对照研究方式选取同队列的64例患者作为非SSI组;采集患者一般资料、手术资料,归纳多发性创伤骨折患者SSI的影响因素。结果单因素分析结果显示,年龄、营养风险、免疫功能障碍、低温、非手术区域感染、住院时间、引流导管留置时间、卧床时间和创伤指数对多发性创伤骨折患者手术部位感染有一定影响(P<0.05);多因素Logistic回归分析显示年龄、营养风险、低温均是多发性创伤骨折患者SSI的影响因素(P<0.001)。结论多发性创伤骨折患者SSI的发生与年龄、营养风险、低温等密切相关,临床应重视具备以上影响因素的患者,积极应对可控因素,降低SSI风险。

OBJECTIVE To analyze the influencing factors of surgical site infection(SSI) in patients with multiple traumatic fractures by applying nested case-control study model, so as to provide reference for prevention and treatment of SSI in patients with multiple traumatic fractures. METHODS Starting with the diagnosis of multiple trauma fractures in the hospital and the end point after discharge, the nested case-control study method was used. From Jan. 2018 to Jul. 2019, patients with SSI were included in the SSI group. When there was 1 SSI patients in the cohort, the patients who had not yet experienced SSI in the cohort were selected synchronously among patients whose admission interval was less than 1 week, the number of fractures were similar(±), and the same gender, who were matched according to the ratio of 1∶2 to non-SSI group. Totally 32 patients with SSI were included in the SSI group, and 64 patients in the same cohort were selected as non SSI group according to the method of nested case-control study. The general data and surgical data of patients were collected, and the influencing factors of SSI in patients with multiple trauma fractures were summarized. RESULTS The results of univariate analysis showed that age, nutritional risk, immune dysfunction, low temperature, non-surgical area infection, hospitalization time, drainage catheter indwelling time, bed time and trauma index had a certain impact on surgical site infection in patients with multiple fractures(P<0.05);multivariate logistic regression analysis showed that age, nutritional risk and hypothermia were all influencing factors of SSI in patients with multiple trauma fractures. CONCLUSION The occurrence of SSI in patients with multiple traumatic fractures is closely related to age, nutritional risk, and hypothermia. Clinical attention should be paid to patients with risk factors, and controllable risk factors should be dealt with actively to reduce the risk of SSI.