骨科Ⅰ类切口手术部位感染情况及危险因素探讨:基于1∶1匹配的病例对照研究-东南大学学报医学版

骨科Ⅰ类切口手术部位感染情况及危险因素探讨:基于1∶1匹配的病例对照研究

单位：1. 徐州仁慈医院感染管理科, 江苏徐州 241004;
2. 南京鼓楼医院感染管理办公室, 江苏南京 21008

分类号：R181

出版年·卷·期（页码）：2024·43·第五期（771-776）

摘要：

目的: 探讨骨科Ⅰ类切口手术部位感染危险因素,为制订感染防控措施提供参考。方法: 收集徐州仁慈医院2017年4月1日至2023年9月30日骨科Ⅰ类切口手术患者资料,填写自编式《骨科Ⅰ类切口手术患者感染监测调查表》,统计手术部位感染的发生情况,感染组与非感染组按照科室、性别、年龄±3岁的原则进行1:1匹配,采用Logistic回归模型分析骨科Ⅰ类切口手术部位感染的危险因素。结果: 共纳入33 584例骨科Ⅰ类切口手术患者,其中147例发生手术部位感染,感染发生率0.44%。多因素分析结果显示,糖尿病、植入物、手术时长≥2 h、手术风险分级(NNIS)评分≥1分和BMI≥25 kg·m^-2是骨科Ⅰ类切口手术部位感染的独立危险因素。结论: 骨科Ⅰ类切口手术部位感染存在诸多危险因素,应采取针对性防控措施以降低感染发生风险。

Objective: To explore the risk factors of surgical site infection in orthopaedic type Ⅰ incision surgery, and to provide reference for infection prevention and control measures. Methods: The data of patients undergoing orthopedic type Ⅰ incision surgery in Xuzhou Renci Hospital from April 1, 2017 to September 30, 2023 were collected. A self-made infection monitoring questionnaire of patients undergoing orthopedic type Ⅰ incision surgery was compiled to analyze the incidence of surgical site infection. The infected group and non-infected group were matched 1:1 according to the principles of department, gender and age ±3 years. Conditional Logistic regression model was used to analyze the risk factors of surgical site infection of type Ⅰ incisions in orthopedics. Results: A total of 33 584 patients with orthopedic type Ⅰ incision surgery were included in this study, of which 147 had surgical site infection,with an infection incidence of 0.44%. Multivariate analysis showed that diabetes, implants, operation duration ≥2 h, National Nosocomial Infections Surveillance(NNIS)score≥1, and BMI≥25 kg·m^-2were independent risk factors for surgical site infection in orthopedic type Ⅰ incisions. Conclusion: There are many risk factors for surgical site infection of orthopedic typeⅠ incision, and targeted prevention and control measures should be taken to reduce the risk of infection.

参考文献：

[1] YANG J,ZHANG X,LIANG W.A retrospective analysis of factors affecting surgical site infection in orthopaedic patients[J].J Int Med Res,2020,48(4):1-9.
[2] 王宝鸿,黄靓妍,王彧杰,等.手术部位感染判定标准研究进展[J].中国消毒学杂志,2023,40(6):460-464.
[3] 吴安华,文细毛,李春辉,等.2012年全国医院感染现患率与横断面抗菌药物使用率调查报告[J].中国感染控制杂志,2014,13(1):8-15.
[4] 茅一萍,徐耀初.外科手术部位感染及其危险因素研究进展[J].中华疾病控制杂志,2009,13(6):707-710.
[5] GILLESPIE B M,CHABOYER W,ERICHSEN-ANDERSSON A,et al.Economic case for intraoperative interventions to prevent surgical-site infection[J].Br J Surg,2017,104(2):e55-e64.
[6] 中华人民共和国卫生部.外科手术部位感染预防与控制技术指南(试行)[S].2010.
[7] 国家卫生与计划生育委员会,国家中医药管理局,解放军总后勤部卫生部药品器材局.抗菌药物临床应用指导原则[S].2015.
[8] APFELBAUM J L,CONNIS R T.The American society of anesthesiologists practice parameter methodology[J].Anesthesiology,2019,130(3):367-384.
[9] GAYNES R P,CULVER D H,HORAN T C,et al.Surgical site infection(SSI) rates in the United States,1992-1998: the National Nosocomial Infections Surveillance System basic SSI risk index[J].Clin Infect Dis,2001,33(Suppl2):S69-S77.
[10] HU X,ZHANG J,LEE J M,et al.Prognostic impact of diabetes mellitus and index of microcirculatory resistance in patients undergoing fractional flow reserve-guided revascularization[J].Int J Cardiol,2020,307(15):171-175.
[11] 李芳.普外科糖尿病患者术后感染因素分析及护理[J].糖尿病新世界,2019,22(16):193-194.
[12] 谢朝云,蒙桂鸾,熊芸,等.乳腺Ⅰ类切口手术部位感染危险因素分析[J].中国消毒学杂志,2020,37(1):27-29.
[13] 计建军,查理,赵利平,等.骨科Ⅰ类切口手术患者术后感染及危险因素分析[J].预防医学,2017,29(7):731-733.
[14] 罗丽,但敏,杨英,等.某医院骨科Ⅰ类切口清洁手术部位感染危险因素分析[J].中国消毒学杂志,2023,40(3):191-193.
[15] 张露,彭杨,张军,等.骨科Ⅰ类切口手术部位感染相关危险因素调查分析[J].中国医药科学,2022,12(12):108-111.
[16] 陈睿,田野,袁文,等.骨科植入物感染的发生及预防的研究进展[J].实用骨科杂志,2017,23(12):1095-1098.
[17] 任海霞,朱欢,高慧儿,等.外科Ⅰ类切口手术部位感染发生率及其影响因素分析[J].中国医院药学杂志,2021,41(5):485-489.
[18] 宋晓超,赵丽娜,乔美珍,等.神经外科Ⅰ类切口手术部位感染的影响因素分析[J].中华医院感染学杂志,2019,29(12):1838-1841,1866.
[19] 郭琳华,杨飞玉,赵智高,等.手术时长对剖宫产术后感染的影响及其相关因素[J].中国妇幼健康研究,2020,31(1):92-95.
[20] 丁丽娜.骨科老年患者术后肺部感染临床特点与危险因素分析[D].重庆:重庆医科大学,2019.
[21] 葛玲.高龄骨科患者术后肺部感染的危险因素分析[J].护理实践与研究,2021,18(9):1317-1320.
[22] 郭丹,姚晋林,蔡建丽,等.2018年—2020年某院骨科患者医院感染的发生情况及其病原学特征分析[J].抗感染药学,2022,19(9):1268-1272.
[23] 张宏侠,葛冰磊,左才红,等.骨科Ⅰ类切口手术部位感染病原菌分析[J].中华肩肘外科电子杂志,2021,9(3):263-267.
[24] ASPIROZ C,MAMA O M,MARTÍNEZ-ÁLVAREZ R M,et al.Penicillin-susceptible Staphylococcus aureus bacteremia: epidemiological and clinical relevance.Possible therapeutic implications[J].Enferm Infec Micr Cl,2020,38(9): 434-437.

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