开放性骨折术后创口发生感染的危险因素分析及诊断指标评价

Analysis of risk factors and evaluation of diagnostic indexes of wound infection after open fracture operation

目的探讨开放性骨折术后创口发生感染的危险因素,评价不同指标对感染的预测能力。方法回顾性分析2019年1月—12月本院骨科收治的586例开放性骨折患者的病案资料。根据患者是否发生术后创口感染,分为感染组105例和未发生感染组481例,采用Logistic回归分析确定开放性骨折患者术后发生感染的危险因素,并以ROC曲线预测相应指标对开放性骨折导致患者术后创口发生感染的预测能力。结果586例四肢开放性骨折患者有105例发生术后创口感染,发生率为17.9%;Logicstic回归分析显示,年龄≥65岁、糖尿病及切口污染等是四肢开放性骨折发生术后创口感染的独立的危险因素(P<0.05)。术前血清白蛋白(≥30 g/L)、预防性使用抗生素为保护性因素,能够降低四肢开放性骨折术后感染率;联合血清IL-6、PCT和CRP3项指标预测发生术后感染的ROC曲线下面积(AUC)为0.946,灵敏度为0.857,特异度为0.864,诊断效率优于任一指标。结论开放性骨折发生术后创口感染的危险因素较多,联合检测血清IL-6、PCT和CRP有利于早期预测感染,指导临床用药,缩短患者住院时间。

Objective To explore the risk factors of infection in wounds after open fracture surgery,and to evaluate the predictive ability of different indicators on infection.Methods Retrospective analysis was performed on the medical records of 586 patients with open fractures admitted to the Department of Orthopedics in our hospital from January 2019 to December 2019.According to whether patients had postoperative wound infections,they were divided into in the infected group(105 cases)and the non-infected group(481 cases).Logistic regression analysis was used to determine the risk factors of postoperative infection in patients with open fractures,and the corresponding indicators of openness were predicted by ROC curve.Fractures lead to the predictive power of infection in the wounds of patients after surgery.Results A total of 105 out of 586 open extremity fracture patients had postoperative wound infection,and the incidence rate was 17.9%;Logistic regression analysis showed that age≥65 years,diabetes and incision contamination were independent of postoperative wound infection in open extremity fracture risk factors(P<0.05).Preoperative serum albumin(≥30 g/L)and prophylactic antibiotic use were protective factors.It can reduce the postoperative infection rate of open fractures of the extremities;combined with the three indicators of serum IL-6,PCT and CRP,the area under the curve(AUC)of the ROC curve to predict postoperative infection is 0.946,sensitivity is 0.857,specificity is 0.864,diagnosis Efficiency is better than any index.Conclusion There are many risk factors for wound infection after open fracture.The combined detection of serum IL-6,PCT and CRP is helpful to predict infection early,guide clinical medication,and shorten the hospital stay of patients.