上肢开放性骨折术后医院感染发生情况分析

doi:10.13217/j.scjpm.2019.0419

摘要/Abstract

摘要： 目的分析某医院骨科上肢开放性骨折术后患者医院感染发生情况及影响因素,为降低术后医院感染发生风险提供依据。方法以2015年11月至2018年4月期间在海东市某医院进行上肢开放性骨折手术的患者为研究对象,分析其术后医院感染发生情况及相关因素。结果本研究共对386例进行手术的开放性骨折患者进行分析,男性217例,女性169例,年龄最小20岁,最大74岁。以上肢单侧肱骨骨折为主（163例,占42.2%）。古斯蒂洛（Gustilo）分型为III A型159例、III B型197例、III C型30例。术后发生医院感染35例,发生率为9.07％。多因素logistic逐步回归分析显示,吸烟史（OR=4.461）、2型糖尿病（OR=4.249）、肺功能低下（OR=5.687）、Gustilo分型为III C型（OR=2.161）、全身麻醉（OR=5.185）、手术时长≥2.5 h（OR=4.951）、术中输血（OR=4.574）、留置导尿时间≥7 d（OR=4.212）、血红蛋白<90 g/L（OR=2.154）、白蛋白≤35 g/L（OR=5.780）、CD4+/CD8+<1（OR=4.236）的患者发生术后医院感染的风险较高。结论上肢开放性骨折术后医院感染发生率相对较高,其危险性因素多样,不定期加强危险性因素筛查,针对高危人群及时采取预防措施,利于降低医院感染率。

关键词: 上肢开放性骨折, 医院感染, 危险因素, 预防

Abstract: Objective To study the risk factors and preventive measures of postoperative nosocomial infection of open fracture of the upper limb.Methods Patients who underwent open upper extremity fracture surgery in a hospital in Haidong City from November 2015 to April 2018 were enrolled in this study. The incidence of postoperative nosocomial infection and related factors were analyzed.Results A total of 386 open fracture patients undergoing surgery were analyzed in this study, including 217 males and 169 females, aged 20-74 years. Of all the patients, 163 （42.2%） were suffered from the unilateral humeral fractures of the upper limbs as the main type. According to Gustilo classification, 159 cases were Type III A, 197 were III B, and 30 were III C. There were 35 cases of postoperative nosocomial infection, with an incidence rate of 9.07%. In the multivariate logistic stepwise regression model, patients with smoking history （OR=4.461）, type 2 diabetes （OR=4.249）, pulmonary hypofunction （OR=5.687）, Gustilo type III C （OR=2.161）, general anesthesia （OR=5.185）, duration of surgery ≥2.5 hours （OR=4.951）, intraoperative blood transfusion （OR=4.574）, indwelling catheterization time ≥7 days （OR=4.212）, hemoglobin <90 g/L （OR=2.154）, albumin ≤35 g/L （OR =5.780）, CD4+/CD8+<1 （OR=4.236） had a higher risk of postoperative nosocomial infection.Conclusion The incidence of postoperative nosocomial infection of open fracture of the upper limb was relatively high and its risk factors were varied. Screening of risk factors from time to time and preventive measures against high-risk groups should be strengthened for reducing the rate of nosocomial infection.

Key words: Upper limb open fracture, Nosocomial infection, Risk factors, Prevention

中图分类号:

R181.3+2

王成龙, 罗岳, 李存宽. 上肢开放性骨折术后医院感染发生情况分析[J]. 华南预防医学, 2019, 45(5): 419-423.

WANG Cheng-long, LUO Yue, LI Cun-kuan. Postoperative nosocomial infection of open fracture of upper limb[J]. South China Journal of Preventive Medicine, 2019, 45(5): 419-423.

参考文献 18

[1]	Fernandes Mde C,Peres LR,de Queiroz AC Jr,et al.Open fractures and the incidence of infection in the surgical debridement 6 hours after trauma[J].Acta Ortop Bras,2015,23(1):38-42.
[2]	Hannigan GD,Pulos N,Grice EA,et al.Current concepts and ongoing research in the prevention and treatment of open fracture infections[J].Adv Wound Care (New Rochelle),2015,4(1):59-74.
[3]	万峰格,邹吉锋,曹海云,等.上肢骨折患者术后伤口医院感染细菌种类与药敏分析[J].中华医院感染学杂志,2017,27(9):2068-2071.
[4]	尹航,王燕,崔立敏.骨折患者医院感染危险因素的meta分析[J].中华医院感染学杂志,2019,29(18):2807-2811.
[5]	许敏,石焱,任晓明,等.开放性骨折患者创口医院感染临床分析与预防对策[J].中华医院感染学杂志,2015,25(14):3286-3288.
[6]	Gaal A,Bailey B,Patel Y,et al.Limiting antibiotics when managing mandible fractures may not increase infection risk[J].J Oral Maxillofac Surg,2016,74(10):2008-2018.
[7]	刘源,刘军,曾鹏,等.开放性骨折手术患者院内医院感染64例调查分析[J].湖南师范大学学报(医学版),2017,3(2):155-157.
[8]	Matos MA,Lima LG,de Oliveira LA.Predisposing factors for early infection in patients with open fractures and proposal for a risk score[J].J Orthop Traumatol,2015,16(3):195-201.
[9]	中华人民共和国卫生部. 医院感染诊断标准(试行)[J]. 中华医学杂志, 2001,81(5):314.
[10]	张春,张俊,吕战虎,等.股骨骨折患者术后医院感染病原菌耐药特征与相关危险因素研究[J].中华医院感染学杂志,2016,26(2): 379-381.
[11]	石颖,苏啸天,王建华,等.四肢开放性骨折患者医院感染的影响因素与预防[J].中华医院感染学杂志,2016,26(11):2547-2549.
[12]	贺逸红,李玉洁,刘海兰.白细胞、C-反应蛋白、降钙素原联合检测在开放性骨折并发医院感染诊断中的应用价值[J].河北医药,2016,1(14):2152-2154.
[13]	Schindeler A,Yu NY,Cheng TL,et al.Local delivery of the cationic steroid antibiotic CSA-90 enables osseous union in a rat open fracture model of Staphylococcus aureus infection[J].J Bone Joint Surg Am,2015,97(4):302-309.
[14]	白博,桑宏勋,吴子祥,等.四肢骨折内固定术后手术部位医院感染危险因素[J].中国医院感染控制杂志,2017,16(4):334-337.
[15]	Blair JA,Stoops TK,Doarn MC,et al.Infection and nonunion after fasciotomy for compartment syndrome associated with tibia fractures:a matched cohort comparison[J].J Orthop Trauma,2016,30(7):392-396.
[16]	赵学寨. 骨科老年手术患者术后金黄色葡萄球菌医院感染危险因素的logistic回归分析[J].中国实验诊断学,2015,19(8):1394-1396.
[17]	Penn-Barwell JG,Bennett PM,Mortiboy DE,et al.Factors influencing infection in 10 years of battlefield open tibia fractures[J].Trategies Trauma Limb Reconstr,2016,11(1):13-18.
[18]	Lingaraj R,Santoshi JA,Devi S,et al.Predebridement wound culture in open fractures does not predict postoperative wound infection: a pilot study[J].J Nat Sci Biol Med,2015,6(1):63-68.