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目的:探讨影响地震创伤患者感染的流行病学特点及可能危险因素。方法:选择2013-04-20-2013-04-27我院收治的来自芦山地震灾区的260例创伤患者为研究对象。采集患者性别、年龄、创伤情况及感染发生情况等资料,分析患者一般情况与感染发生的关系。结果:260例患者中出现感染患者90例130例次,其中医院感染发生率为12.3%(32/260)。在90例并发感染的患者中,呼吸道感染53例次,伤口感染40例次,泌尿系感染11例次,胃肠道感染9例次,血液感染6例次,导管相关性感染6例次,五官和口腔感染5例次。共采集感染相关标本203份送微生物学检测,分离出的菌株包括鲍曼不动杆菌27例(28.4%)、大肠埃希菌23例(24.2%)、肺炎克雷伯杆菌15例(15.8%)、金黄色葡萄球菌14例(14.7%)、阴沟肠杆菌10例(10.5%)和其他6例(6.3%)。单因素基线资料比较中发现,感染组和非感染组患者的性别、受伤时间、多发伤、RTS评分、CRAMS评分、PHI评分比较差异无统计学意义。多元回归分析发现患者年龄、住院时间、入住ICU是地震创伤患者发生感染的主要危险因素(P<0.05)。结论:年龄、住院时间、入住ICU是地震伤员开放性创伤患者发生细菌感染的危险因素,提示在快速抢救伤员的同时,重视感染的危险因素,完善院感预防机制,采用有效措施控制创伤感染,对减少医院感染、改善患者预后有重要意义。
Objective: To explore the epidemiological characteristics and possible risk factors affecting the patients with earthquake trauma. Methods: Choose from 2013-04-20-2013-04-27 hospital in our hospital from Lushan earthquake-stricken 260 cases of traumatic patients as the research object. Collect the patient’s gender, age, trauma and infection and other information, analysis of the general situation of patients and the relationship between infection. Results: Among the 260 patients, 90 patients were infected with 90 cases, of which 12.3% (32/260) were hospital infection. Among the 90 patients with concurrent infections, 53 were respiratory infections, 40 were wound infections, 11 were urinary tract infections, 9 were gastrointestinal infections, 6 were blood infections and 6 were catheter-related infections. Five organs and oral infections in 5 cases. A total of 203 samples were collected for microbiological detection. The isolated strains included Acinetobacter baumannii in 27 cases (28.4%), Escherichia coli in 23 cases (24.2%), Klebsiella pneumoniae in 15 cases (15.8% ), Staphylococcus aureus in 14 cases (14.7%), Enterobacter cloacae in 10 cases (10.5%) and the other 6 cases (6.3%). Single-factor baseline data found no significant difference in gender, injury time, multiple trauma, RTS score, CRAMS score and PHI score between infected and non-infected patients. Multivariate regression analysis found that patient age, length of stay, and ICU occupancy were the major risk factors for infection in earthquake-hit patients (P <0.05). Conclusion: Age, length of hospital stay and ICU occupancy are the risk factors for bacterial infection in open wounds of earthquake casualty patients. It is suggested that the risk factors of infection should be emphasized in rapid rescue of the injured and the mechanism of nosocomial prophylaxis should be improved. Effective measures should be taken to control the wound infection, It is of great significance to reduce nosocomial infection and improve the prognosis of patients.