摘要
目的探讨和分析骨科清洁切口手术部位感染的危险因素,总结和提出降低骨科清洁切口SSI发病率的预防控制措施。方法选择某三甲医院2015年6月-2016年12月实施骨科清洁手术的患者为研究对象,收集患者人口统计学资料、基础疾病史(高血压及糖尿病等)、术前ASA评分、皮肤准备方法、围手术期抗菌药物使用情况、手术时间、手术类型、操作者资历、急诊手术、留置引流管、手术部位感染情况。采用2001年卫生部发布的《医院感染诊断标准(试行)》进行感染诊断,采用单因素卡方检验和多因素Logistic回归方法分析骨科清洁切口手术的感染危险因素。结果共监测患者792例,发生SSI 17例,SSI发病率为2.15%。单因素分析结果显示,患者高龄、患有糖尿病等基础疾病、ASA评分Ⅲ级以上、急诊手术是骨科清洁切口SSI相关阳性危险因素(均P<0.05)。将单因素分析的4个危险因素以及临床上普遍认为高危的2个因素(传统备皮方法、手术时间>180 min)引入多因素logistic回归分析,结果显示,患者ASA评分Ⅲ级以上、传统备皮法、手术时间>180 min、急诊手术为骨科清洁手术后SSI的独立危险因素。结论患者ASA评分Ⅲ级以上、传统备皮法、手术时间>180 min、急诊手术会增加骨科清洁手术后SSI的风险,医务人员应充分认识和了解这些危险因素,在围手术期最大可能地优化各项可调控因素,最大限度地降低骨科清洁切口SSI的发生率。
Objective To analyze the risk factors for surgical site infection（SSI）in clean wound orthopedics surgery,and to explore how to control it. Methods SSI among patients receiving clean wound orthopedic surgery from June 2015 to December 2016 were monitored,Chi-square test was used to analyze the related influencing factors（age,ASA score,skin preparation modes,operation time,types of surgery,use of Antibacterials,drainage tube indwelling） of postoperative infection in clean wound orthopedics surgery,multiple Logistic regressions were used to analyze the positive risk factors. Results A total of 792 patients were monitored,17 cases（2.15%）of SSI occurred. The results of chi-square test showed that elder age,ASA score〉 grade Ⅲ,conventional skin preparation, long operation time,complicated operation type,irrational use of antibiotics might increase the risk of clean wound orthopedic surgical infection（all P values 〈0.05）,but patients. gender,the surgeons. level and operation skill,drainage tube indwelling did not. Multiple Logistic regressions results showed that ASA score ≥ gradeⅢ,conventional skin preparation and long operation time might increase the risk the clean wound orthopedic surgical infection,and the highest risk factors was long operation time（3〉 h）,and then ASA score ≥grade Ⅲ and conventional skin preparation.[OR（95%CI）,4.08（1.36-12.35）,3.46（1.98-21.12）,2.97（1.08-14.71）]. Conclusion Elder age,ASA score ≥ grade Ⅱ and conventional skin preparation may increase the risk of clean wound orthopedic surgical infection. Medical staff should be fully aware of these risk factors,optimize the regulatory factors most in perioperative period and maximally reduce the incidence for SSI in clean wound orthopedics surgery.
作者
潘丽芬
谭淑芳
曹林岚
冯晓玲
PAN Lifen;TAN Shufang;CAO Linlan;FENG Xiaoling(Operation Room,Sun Yat-sen,Memorial Hospital,Sun Yat-sen University,Guangzhou 510120;Operation Room,First People＇s Hospital of Kashi,Xinjiang 844000,China)
出处
《岭南现代临床外科》
2018年第3期367-371,共5页
Lingnan Modern Clinics in Surgery
基金
广东省公益研究与能力建设专项资金项目(2014A020209020)
关键词
骨科
清洁手术
清洁切口
皮肤准备
目标性监测
手术部位感染
危险因素
orthopedics
clean operation
clean wound
skin preparation
targeted monitoring
surgical site infection
Risk factors
