目的:尽管断肢再植的情况越来越多,术后伤口感染会增加患者的经济和心理负担。这里,本研究旨在探讨术后伤口感染的病原菌分布及危险因素,以帮助早期识别和管理高危患者.
方法:将2014年11月9日至2022年9月6日在苏州瑞兴医疗集团接受再植的外伤性大肢切断的成年住院患者纳入回顾性研究。人口统计,和临床特征,治疗,并收集结果。数据用于分析术后切口感染的危险因素。
结果:在249名患者中,185(74.3%)为男性,中位年龄为47.0岁.术后伤口感染74例(29.7%),其中51人(20.5%)感染了多重耐药细菌。缺血时间(OR1.31,95%CI1.13-1.53,P=0.001),伤口污染(OR6.01,95%CI2.38-15.19,P<0.001),应激性高血糖(OR23.37,95%CI2.30~236.93,P=0.008)是独立危险因素,而术后白蛋白水平(OR0.94,95%CI0.89-0.99,P=0.031)与术后伤口感染的减少显着相关。缺血时间(OR1.21,95%CI1.05-1.40,P=0.010),伤口污染(OR8.63,95%CI2.91-25.57,P<0.001),MESS(OR1.32,95%CI1.02~1.71,P=0.037是多重耐药菌感染的独立危险因素。
结论:严重外伤性大肢残割患者再植后伤口感染较为常见,大多数是多重耐药细菌。缺血时间和伤口污染与术后伤口感染的增加有关,包括多重耐药引起的。积极纠正低蛋白血症和控制应激性高血糖可能是有益的。
OBJECTIVE: Even though replantation of limb mutilation is increasing, postoperative wound infection can result in increasing the financial and psychological burden of patients. Here, we sought to explore the distribution of pathogens and identify risk factors for postoperative wound infection to help early identification and managements of high-risk patients.
METHODS: Adult inpatients with severed traumatic major limb mutilation who underwent replantation from Suzhou Ruixing Medical Group between November 09, 2014, and September 6, 2022 were included in this retrospective study. Demographic, and clinical characteristics, treatments, and outcomes were collected. Data were used to analyze risk factors for postoperative wound infection.
RESULTS: Among the 249 patients, 185 (74.3%) were males, the median age was 47.0 years old. Postoperative wound infection in 74 (29.7%) patients, of whom 51 (20.5%) had infection with multi-drug resistant bacteria. Ischemia time (OR 1.31, 95% CI 1.13-1.53, P = 0.001), wound contamination (OR 6.01, 95% CI 2.38-15.19, P <0.001), and stress hyperglycemia (OR 23.37, 95% CI 2.30-236.93, P = 0.008) were independent risk factors, while the albumin level after surgery (OR 0.94, 95% CI 0.89-0.99, P = 0.031) was significant associated with the decrease of postoperative wound infection. Ischemia time (OR 1.21, 95% CI 1.05-1.40, P = 0.010), wound contamination (OR 8.63, 95% CI 2.91-25.57, P <0.001), and MESS (OR 1.32, 95% CI 1.02-1.71, P = 0.037 were independent risk factors for multi-drug resistant bacteria infection.
CONCLUSIONS: Post-replantation wound infection was common in patients with severe traumatic major limb mutilation, and most were multi-drug resistant bacteria. Ischemia time and wound contamination were associated with the increase of postoperative wound infection, including caused by multi-drug resistant. Positive correction of hypoproteinemia and control of stress hyperglycemia may be beneficial.