骨科清洁切口手术部位感染监测及危险因素

摘要

目的：了解骨科清洁切口手术部位感染（SSI）发病率和 SSI 危险因素。方法对某院2014年4月1日—9月30日实施骨科清洁手术的患者进行 SSI 监测，分析其危险因素。结果共监测患者665例，发生 SSI 14例，SSI发病率为2．11％。单因素分析结果显示，手术类型、皮肤准备方法、ASA 评分和手术时间均是骨科清洁切口发生 SSI的危险因素（均 P ＜0．05）。多因素 logistic 分析结果显示：传统备皮法、ASA 评分Ⅱ级及以上、手术时间≥90 min 是骨科清洁手术患者发生 SSI 的独立危险因素[OR 及 OR95％CI 分别为3．96（1．07－14．70）、6．45（1．97－21．11）、4．08（1．35－12．30）]。结论改良备皮法、ASA 评分 I 级及手术持续时间越短可减少骨科清洁切口 SSI 的发生，临床在提高患者自身免疫力的前提下，加强医院感染预防与控制，有助于降低骨科清洁切口 SSI 发病率。%Objective To investigate the incidence and risk factors for surgical site infection (SSI)in clean wound orthopedics surgery.Methods SSI among patients receiving clean wound orthopedic surgery from April 1 to Sep-tember 30 in 2014 were monitored,risk factors for SSI were analyzed.Results A total of 665 patients were moni-tored,14 cases(2.11 %)of SSI occurred.Univariate analysis showed that types of skin,skin preparation modes, and ASA score were risk factors for SSI in clean wound orthopedic surgery (all P <0.05 ).Multivariate logistic analysis revealed that conventional skin preparation,ASA score ≥ grade Ⅱ,and duration of operation ≥90 minutes were independent risk factors for SSI in patients receiving clean wound orthopedic surgery (OR [95%CI ],3.96 [1 .07-14.70],6.45[1 .97-21 .11],and 4.08[1 .35 -12.30]respectively).Conclusion The improved method of skin preparation,grade I ASA score,and shortening duration of operation can reduce the incidence of SSI in clean wound orthopedic surgery,on the basis of improving the autoimmunization of patients,strengthening prevention and control of healthcare-associated infection can reduce the incidence of SSI in clean wound orthopedic surgery.