肱骨近端骨折病人手术部位感染的危险因素分析

Risk factors of surgical site infection in patients with proximal humeral fractures

目的分析肱骨近端骨折手术病人术后切口感染危险因素,为术后切口感染的预防提供依据。方法选取2015年5月～2018年5月在某院骨科收治的肱骨近端骨折病人166例作为研究对象。采用回顾性调查方法分析术后病人手术部位感染的相关因素及病原菌构成比。结果 166例肱骨近端骨折病人中发生术后切口感染者20例,感染率为12. 05%。共检出21株病原菌,其中革兰氏阴性菌12株(57. 14%)、革兰氏阳性菌8株(38. 10%)、真菌1株(4. 76%)。主要有大肠埃希菌(5株,占23. 81%)、金葡菌(4株,占19. 06%)、铜绿假单胞菌(3株,占14. 29%)。单因素分析结果显示,肱骨近端骨折病人术后切口感染的发生与病人年龄(χ~2=3. 870)、受伤至入院时间(χ~2=15. 200)、麻醉方式(χ~2=26. 446)、手术性质(χ~2=7. 756)、手术时间(χ~2=4. 586)、伤口清创(χ~2=9. 712)、是否合并糖尿病(χ~2=6. 371)、抗菌药物使用(χ~2=5. 053)有关(P <0. 05),与病人性别(χ~2=0. 027)、术前外周血白细胞(χ~2=3. 879)及ASA分级(χ~2=0. 512)无关(P>0. 05)。经多因素分析显示,高龄病人、受伤至入院时间长、全麻、急诊手术、手术持续时间长、污染伤口、合并有糖尿病以及抗菌药物使用不合理均为引起术后切口感染的独立危险因素。结论骨科病人术后切口感染的发生率较高,根据引起切口感染的相关因素采取有效的预防措施,减少骨科病人术后切口感染的发生。

Objective To analyze the risk factors of postoperative incision infection in patients with proximal humerus fracture surgery,and provide evidence for prevention of postoperative wound infection.Methods A total of 166 patients with proximal humeral fractures admitted to the orthopedics department from May 2015 to May 2018 were selected as subjects.Retrospective investigation was used to analyze the related factors and pathogen composition ratio of surgical site infection in postoperative patients.Results Among the 166 patients with proximal humeral fractures,20 cases were infected with postoperative incision,the infection rate was 12.05%.A total of 21 pathogenic bacteria were detected,including 12 strains of gram-negative bacteria(57.14%),8 strains of gram-positive bacteria(38.10%),1 strain of the fungus(4.76%).The major pathogen is escherichia coli(5 strains,23.81%),staphylococcus aureus(4 strains,19.06%),pseudomonas aeruginosa(3 strains,14.29%).Single factor analysis showed that the incidence of postoperative incision infection in patients with proximal humerus fractures was related to the age of the patient(χ~2=3.870),time from injury to admission(χ~2=15.200),anesthesia mode(χ~2=26.446),surgical nature(χ~2=7.756),operative time(χ~2=4.586),debridement of wound(χ~2=9.712),whether or not diabetes(χ~2=6.371),antibacterial drug use(χ~2=5.053),P<0.05;it was not related to the patient’s gender(χ~2=0.027),preoperative leukocyte(χ~2=3.879)and ASA grading(χ~2=0.512),P>0.05.Multivariate analysis showed that elderly patients,long-term injury to hospital admission,general anesthesia,emergency surgery,long duration of surgery,contaminated wounds,combined with diabetes,and practical and unreasonable antibacterial agents were independent risk factors for postoperative wound infection.Conclusion The incidence of postoperative incision infection is higher in orthopedic patients,and effective preventive measures are taken according to the factors related to the infection of the incision,which reduce the incidence of postoperative incision infection in orthopedic patients.