外伤患者伤口感染危险因素及预防的对策.docVIP

外伤患者伤口感染危险因素及预防的对策 　　[摘要] 目的 了解外伤患者伤口感染的危险因素，为探讨有效的预防对策提供科学依据。 方法 选取2015年1月～2016年6月在本院急诊收治的开放性外伤患者共87例，对患者相关临床资料和伤口感染率作分类统计。 结果 入院后第3、6天对87例外伤患者的130个外伤部位作细菌培养，有25例患者的40个伤口部位阳性，证明发生感染，病例感染率为28.7%，部位感染率为30.8%；不同外伤类型的伤口感染率略有不同，其中车祸伤（41.7%）和坠落伤（40.0%）较高，但比较差异无统计学意义（P0.05）；感染部位共分离病原菌40株，主要病原菌为大肠埃希菌14株，金黄色葡萄球菌12株和铜绿假单胞菌6株；受伤时间超过3 h、伤口严重污染及多部位创伤是伤口感染的危险因素。 结论 加强对一线急救医务人员外伤急救基本知识和基本技能的培训，尽早对伤口周围皮肤消毒，对伤口做好清创、排污、缝合、消毒等初步处理，清除伤口内异物、血液凝块和坏死组织，合理使用抗菌药物，是降低患者伤口感染率的有效措施。 　　[关键词] 外伤；伤口感染；危险因素；预防对策 　　[中图分类号] R639 [文献标识码] B [文章编号] 1673-9701（2017）15-0077-04 　　[Abstract] Objective To explore the risk factors of wound infection in trauma patients and to provide scientific basis for preventive strategy. Methods 87 patients with open trauma treated in our hospital from January 2015 to June 2016 were selected and their clinical data and rate of wound infection were recorded. Results Bacterial culture was conducted at 130 sites of wound in 87 patients at the third day and the sixth day after admission， and 40 sites of wound （30.8%） in 25 patients（28.7%） were positive infected. The infection rates were different in different kinds of trauma， which were higher in car accident（41.7%） and fall injury（40.0%）， but it showed no significant difference（P0.05）. 40 strains of pathogenic bacteria were separated from the infected sites， of which 14 were ecoli， 12 were staphylococcus aureus， and 6 were pseudomonas aeruginosa. Injury time 3 h， severe contamination of wound and multi-site trauma were risk factors of wound infection. Conclusion More knowledge and skill training on trauma first-aid is needed among medical staff. Skin degerming should be done as early as possible. Primary management such as debridement， drainage， suture， and sterilization should be conducted. Foreign matters， blood coagulum， and necrotic tissues should be cleaned out， and antibacterial agents should be used reasonably. The above measures are helpful to reduce the infection rate of wound in trauma patients. 　　[Key words]