ICU骨科术后患者并发感染的危险因素分析

Analysis of Risk Factors of Infection Following Orthopedic Operation in ICU

目的探讨分析重症监护病房(ICU)骨科术后患者并发感染的相关危险因素。方法选取2020年6月至2022年6月南阳市中心医院综合ICU收治的86例骨科术后患者作为研究对象,收集患者性别、年龄、体重指数、骨折类型、美国麻醉医师协会(ASA)分级、手术时间、切口类型、是否输血、是否进行机械通气、抗菌药物使用时间、ICU入住时间以及是否合并高血压、糖尿病及骨质疏松等资料,并根据术后30 d内是否发生感染将患者分为感染组与未感染组,多因素Logistic回归分析ICU骨科术后患者并发感染的相关危险因素。结果86例患者中术后发生感染14例(16.28%),设为感染组;未发生感染72例(83.72%),设为未感染组。单因素分析结果显示,感染组年龄≥65岁、手术时间≥2 h、切口类型为Ⅲ类、进行机械通气、抗菌药物使用时间≥7 d、ICU入住时间≥7 d以及合并糖尿病的患者比例明显高于未感染组(χ^(2)=9.260、11.427、9.108、5.917、16.124、9.101、15.849,P=0.002、P=0.001、P=0.011、P=0.015、P<0.001、P=0.003、P<0.001);多因素Logistic回归分析结果显示,手术时间≥2 h、进行机械通气、抗菌药物使用时间≥7 d、合并糖尿病是ICU骨科术后患者并发感染的独立危险因素(95%CI为1.190~9.430、1.550~17.957、1.328~17.859、2.244~16.702,P=0.022、0.008、0.017、0.000)。结论ICU骨科术后患者的感染发生情况与手术时间、是否进行机械通气、抗菌药物使用时间以及是否合并糖尿病密切相关。

Objective To investigate the relevant risk factors of infection following orthopedic operations in the intensive care unit(ICU).Methods 86 patients,who were admitted into the general ICU and underwent orthopedic oper⁃ations in Nanyang Central Hospital between June 2020 and June 2022,were enrolled as research subjects,and the data of patients were collected,including sex,age,body mass index,fracture type,American Society of Anesthesiologists(ASA)classification,operation time,incision type,receiving blood transfusion and mechanical ventilation or not,duration of taking antibacterial agents,length of ICU stay,being complicated with hypertension,diabetes and osteoporosis or not.The patients were divided into infection group and non⁃infection group based on whether infection occurred within 30 days after operation,and multivariate Logistic regression analysis was conducted to analyze the relevant risk factors of infection follow⁃ing orthopedic operations in the ICU.Results Among the 86 patients,14 patients(16.28%)developed postoperative infection,being set as infection group,and the other 72 patients(83.72%)without postoperative infection were set as non⁃infection group.Univariate analysis showed that the proportions of patients with age≥65 years,operation time≥2 h,incision typeⅢ,mechanical ventilation,duration of taking antibacterial agents≥7 d,length of ICU stay≥7 d,and diabe⁃tes in the infection group were all higher than that in the non⁃infection group(χ^(2)=9.260,11.427,9.108,5.917,16.124,9.101 and 15.849,P=0.002,P=0.001,P=0.011,P=0.015,P<0.001,P=0.003,P<0.001).Multi⁃variate Logistic regression analysis showed that operation time≥2 h,receiving mechanical ventilation,duration of taking antibacterial agents≥7 d and being complicated with diabetes were independent risk factors of infection occurrence following orthopedic operations in the ICU(95%CI:1.190-9.430,1.550-17.957,1.328-17.859,2.244-16.702,P=0.022,0.008,0.017 and 0.000).Conclusion The occurrence of infection following orthopedic operations in the ICU was closely associated with patients’operation time,receiving mechanical ventilation or not,duration of taking antibacterial agents,and being complicated with diabetes or not.