跟骨开放性骨折术后切口感染危险因素及与机体免疫功能和营养状态的关系

Risk factors for postoperative incision infections in patients with open calcaneal fracture and association with immune function and nutritional status

目的探讨跟骨开放性骨折术后切口感染危险因素及与机体免疫功能和营养状态关系。方法选择2021年5月-2023年4月河北医科大学第三医院跟骨开放性骨折患者120例为研究对象,根据术后切口感染发生情况分为感染组31例与非感染组89例。分离鉴定感染病原菌;多因素Logistic回归分析术后切口感染危险因素;比较两组免疫功能和营养状态变化。结果术后切口感染31例,分离病原菌34株,以革兰阴性菌为主。单因素分析,感染组与非感染组性别、体质量指数、吸烟史、骨折原因、Sanders骨折分型、合并高血压和植骨比较,无统计学差异;感染组年龄>60岁占比高于非感染组,合并糖尿病占比高于非感染组,手术时间长于非感染组,差异均有统计学意义(P<0.05)。经多因素Logistic回归分析,年龄、合并糖尿病、手术时间为影响跟骨开放性骨折术后切口感染危险因素。感染组CD3+、CD4+和CD4+/CD8+低于非感染组,而CD8+高于非感染组(P<0.05)。感染组血红蛋白(Hb)、白蛋白(ALB)和前白蛋白(PA)水平低于非感染组(P<0.05)。结论跟骨开放性骨折术后切口感染病原菌以革兰阴性菌为主,术后切口感染相关危险因素较多;且切口感染患者机体免疫功能和营养状态下降。

OBJECTIVE To explore the risk factors for postoperative incision infections in the patients with open calcaneal fracture and observe the association with immune function and nutritional status.METHODS A total of 120 patients with open calcaneal fracture who were treated in the Third Hospital of Hebei Medical University from May 2021 to Apr.2023 were recruited as the research subjects and were divided into the infection group with 31 cases and the non-infection group with 89 cases according to the status of postoperative incision infection.The pathogens causing the infections were identified,multivariate logistic regression analysis was performed for the risk factors for the postoperative incision infections,and the immune function and nutrition indexes were observed and compared between the two groups.RESULTS Totally 34 strains of pathogens were isolated from the 31 patients with postoperative incision infections,among which gram-negative bacteria.Univariate analysis showed that there were no significant differences in gender,body mass index,smoking history,causes of fracture,Sanders fracture classification,complication with hypertension and bone grafting between the infection group and the non-infection group.The proportion of patients aged more than 60 years old was higher in the infection group than in the non-infection group,the proportion of patients complicated with diabetes mellitus was higher in the infection group than in the non-infection group,the operation duration of the infection group was longer than that of the non-infection group(P<0.05).Multivariate logistic regression analysis indicated that the age,complication with diabetes mellitus and operation duration were the risk factors for the postoperative incision infections in the patients with open calcaneal fractur.The CD_(3)^(+),CD_(4)^(+)and CD_(4)^(+)/CD_(8)^(+)of the infection group were lower than those of the non-infection group,while the CD_(8)^(+)level of the infection group was higher than that of the non-infection group(P<0.05).The levels of hemoglobulin(Hb),albumin(ALB)and prealbumin(PA)of the infection group were lower than those of the non-infection group(P<0.05).CONCLUSIONS The gram-negative bacteria are dominant among the pathogens isolated from the open calcaneal fracture patients with postoperative incision infections.There are a variety of risk factors for the postoperative incision infections.The patients with the incision infections show the decline of immune function and nutritional status.