GustiloⅢ型开放性骨折术后医院感染危险因素及负压封闭引流技术的疗效评价

发布时间：2018-02-02 08:37

本文关键词： GustiloⅢ型开放性骨折院内感染危险因素负压封闭引流　出处：《中华医院感染学杂志》2017年19期 　论文类型：期刊论文

【摘要】：目的分析GustiloⅢ型开放性骨折术后院内感染的危险因素,并探究负压封闭引流技术对该术后的治疗效果。方法选择2013年1月-2016年6月在医院治疗的1020例GustiloⅢ型开放性骨折术后患者,回顾分析临床资料,对术后医院感染的危险因素进行分析。另选择同期1020例GustiloⅢ型开放性骨折术后患者,根据治疗方式分为实验组583例、对照组437例,实验组采用负压封闭引流治疗,对照组采用常规换药治疗,比较两组创面愈合时间、骨折愈合时间、住院时间及术后3月内创面细菌转阴率及愈合率。结果 1020例患者院内感染20例,感染率为1.96%;多因素logistic结果显示:年龄60岁、损伤程度为ⅢB或ⅢC、治疗间隔6h、手术时长2.5h、住院时间10d、术前使用抗菌药物或激素、术中采用全身麻醉方式及术后未使用负压封闭引流等是院内感染的危险因素;实验组创面愈合时间、骨折愈合时间及住院时间分别为(10.93±10.88)d、(211.32±18.03)d和(15.96±2.43)d均短于对照组(19.07±1.69)d、(263.42±20.49)d和(24.01±3.11)d,差异有统计学意义(P0.05),术后3月内细菌转阴率及创面愈合率均显著高于对照组(P0.05)。结论负压封闭引流术具有缩短愈合时间、加速创口愈合、降低医院感染率等特点,治疗效果优良。
[Abstract]:Objective to analyze the fracture risk of postoperative nosocomial infections of Gustilo type III open factors, and explore the vacuum sealing drainage on the postoperative therapeutic effect. Methods -2016 year in June in the hospital in January 2013 1020 cases of Gustilo type of open fracture patients after surgery, were retrospectively analyzed the clinical data of postoperative nosocomial infection risk. The factors were analyzed. Selected 1020 cases of Gustilo type of open fracture patients after operation, according to the treatment methods were divided into experimental group 583 cases, 437 cases in the control group, the experimental group used the vacuum sealing drainage treatment, the control group were given the conventional treatment, compared two groups of the wound healing time, fracture healing time, hospitalization time and after March in bacterial conversion rate and healing rate. Results 1020 cases of patients with nosocomial infection in 20 cases, the infection rate was 1.96%; multivariate logistic results show: 60 years of age, the extent of damage to B III or III C, therapy Every 6h, operation time 2.5h, hospitalization time 10d, preoperative use of antibiotics or hormone treated by surgery and general anesthesia without the use of vacuum sealing drainage are the risk factors for nosocomial infection; time of wound healing in experimental group, the healing time and hospitalization time were fracture (10.93 + 10.88) d. (211.32 + 18.03) D and (15.96 + 2.43) d is shorter than the control group (19.07 + 1.69) d, (263.42 + 20.49) D and (24.01 + 3.11) d, the difference was statistically significant (P0.05), the rate was significantly higher than the control group and the negative rate of bacteria in wound healing after surgery (March P0.05). Conclusion VSD can shorten the healing time, accelerate wound healing, reduce the rate of nosocomial infection, the treatment effect is good.

【作者单位】：海南医学院第一附属医院关节创伤外科;
【分类号】：R687.3
【正文快照】： 开放性骨折是在骨折时,合并有覆盖骨折部位的皮肤及皮下软组织损伤破裂,使骨折断端与外界相通,在骨折中病情程度较严重[1]。国外学者An-derson早前依据软组织损伤的程度将开放性骨折分为3型:Ⅰ型、Ⅱ型和Ⅲ型,首次将开放性骨折细化及分类,给诊断和治疗带来针对性[2]。1984年Gu

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