骨科植入术患者应用集束化策略预防手术部位感染的效果

Effect of the prevention of surgical site infection in patients with orthopaedic implantation using a bundle strategy

目的:探讨骨科植入术患者应用集束化策略对预防其手术部位感染的效果。方法:选择2020年3月至2022年3月无锡市第九人民医院收治的行骨科植入术患者1800例,采用随机数字表法分为两组,各900例。对照组实施常规干预,试验组在此基础上实施集束化策略。比较两组手术部位感染发生率、围手术期各项指标情况、术后血清炎症因子水平变化,分析病原菌分布情况及手术部位感染的革兰氏阳性菌、革兰氏阴性菌药敏试验结果。结果:试验组手术部位感染发生率为1.44%(13/900),对照组手术部位感染发生率为2.78%(25/900),差异有统计学意义(P<0.05);试验组术中出血量、住院时间少于对照组,术后血红蛋白高于对照组(P<0.05);试验组术后第2天的C反应蛋白(C-reaction protein,CRP)、白细胞介素(interleukin,IL)-6、I L-10、肿瘤坏死因子-α(tumor necrosis factorα,TNF-α)水平均低于对照组,术后第5天的白细胞计数(white blood cell,WBC)、CRP、降钙素原(procalcitonin,PCT)、IL-6、IL-10、IL-1β、TNF-α水平均低于对照组(均P<0.05)。1800例患者中共38例发生手术部位感染,分离培养出病原菌43株,其中革兰氏阳性菌19株、革兰氏阴性菌23株、真菌1株。经革兰氏阳性菌药敏试验,金黄色葡萄球菌与表皮葡萄球菌对氨苄西林、头孢唑林耐药率最高,对万古霉素敏感率最高,达100%。经革兰氏阴性菌药敏试验,大肠埃希菌对环丙沙星、左氧氟沙星的耐药率均较高,对多黏菌素敏感率最高,达100%;铜绿假单胞菌对多黏菌素敏感率最高,达100%。结论:骨科植入术患者应用集束化策略可有效降低血清炎症因子水平,减少手术部位感染发生,从而改善预后。

Objective:To investigate the effect of application of bundle strategy on the prevention of surgical site infection in patients undergoing orthopaedic implantation.Methods:A total of 1800 patients with orthopaedic implantation who were admitted to Wuxi Ninth People’s Hospital from March 2020 to March 2022 were selected and divided into 2 groups by random number table method,with 900 cases in each group.The control group implemented the conventional infection control program,and the experimental group implemented the bundle strategy on this basis.The incidence of surgical site infection,perioperative indicators,and postoperative serum inflammatory factor levels were compared between the 2 groups.Results:The incidence of surgical site infection in the experimental group was 1.44%(13/900),and the incidence of surgical site infection in the control group was 2.78%(25/900),the difference was statistically significant(P<0.05).The amount of intraoperative blood loss and hospital stay in the experimental group were less than those in the control group.The postoperative hemoglobin was higher than that of the control group(P<0.05);the levels of C-reaction protein(CRP),interleukin(IL)-6,IL-10,and tumor necrosis factor-α(TNF-α)in the experimental group on the 2nd postoperative day were lower than those in the control group,and the levels of WBC,CRP,procalcitonin(PCT),IL-6,IL-10,IL-1β,and TNF-αin the experimental group on the 5th postoperative day were lower than those in the control group(all P<0.05).A total of 38 of the 1800 patients developed surgical site infection,and 43 pathogenic bacteria were isolated and cultured,including 19 Gram-positive bacteria,23 Gram-negative bacteria,and 1 fungus.The Gram-positive bacteria susceptibility test showed that Staphylococcus aureus and Staphylococcus epidermidis had the highest resistance rate to ampicillin and cefazolin,and the highest sensitivity rate to vancomycin,reaching 100%.The drug susceptibility test of Gram-negative bacteria showed that the resistance rates of Escherichia coli to ciprofloxacin and levofloxacin were high;the sensitivity rate to polymyxin was the highest,reaching 100%;Pseudomonas aeruginosa was resistant to polymyxa.The highest sensitivity rate was 100%.Conclusion:The application of bundle strategy in patients with orthopaedic implantation can effectively reduce the level of serum inflammatory factors and reduce the occurrence of surgical site infection,thereby improving the prognosis.