预防手开放损伤感染的微生物检查与治疗

[摘要]目的 探讨微生物检查在手开放性损伤患者感染预防中的应用价值。方法 选取2011年7月～2016年7月本院收治的200例手开放性损伤患者，采用随机数字表法将其分为A组与B组各100例，A组患者在清创后按常方式给予抗生素药物，B组患者在清创前开展细菌培养与药敏试验，根据其监测结果开展抗感染治疗。统计观察B组患者的实验室检查结果，并比较两组患者用药时间、住院时间、伤口感染率与伤口愈合程度。结果 B组患者经实验室检查发现细菌感染69例，检出致病菌81株，其中革兰阴性杆菌65株（80.2%）、革兰阳性球菌15株（18.5%）、真菌1株（1.2%），革兰阴性杆菌中主要以大肠埃希菌与铜绿假单胞菌为主，革兰阳性球菌中以金黄色葡萄球菌为主。B组患者的用药时间、住院时间与伤口愈合程度均显著好于A组，差异有统计学意义（P

[关键词]手开放性损伤；微生物检查；感染预防

[中图分类号] R639 [文献标识码] A [文章编号] 1674-4721（2017）01（c）-0064-04

[Abstract]Objective To explore the application value of microbiological examination in the prevention of infection in patients with hand open injury.Methods 200 cases of hand open injury in our hospital from July 2011 to July 2016 were selected and divided into group A and group B by random number table method，each group of 100 cases.Patients in group A were given antibiotics in routine way after debridement，bacterial culture and drug sensitivity test were carried out in patients of group B before debridement according to monitoring results to carry our infection treatment.The results of laboratory tests were observed in patients with group B，and medication time，length of stay，wound infection rate and wound healing were compared between two groups.Results 69 cases of bacterial infection were found by laboratory examination in group B，and 81 strains of pathogenic bacteria were detected.Among them，65 strains （80.2%） were gram negative bacilli，15 strains （18.5%） were gram positive bacteria and 1 strain （1.2%） was fungi.Escherichia coli and Pseudomonas aeruginosa were the main pathogens in gram negative bacteria，and staphylococcus aureus in gram positive bacteria.Medication time，length of stay and wound healing in group B were significantly better than those in group A，with statistical significance （P

[Key words]Hand open injury；Microbiological examination；Infection prevention

手部损伤的临床发病率较高，其中大部分患者均为开放性损伤[1]，而伤口污染是此类患者常见的临床并发症，感染不仅会影响局部愈合与手部功能恢复，严重者甚至出现致残或危及生命等风险[2]。目前，临床主要采用清创与抗感染等方式预防伤口污染[3]，但大部分医院仍然采用经验性抗生素用药方式，导致抗感染预防效果较差，促使骨科医师对开放性损伤患者的微生物检查越发关注。根据其伤口细菌感染情况给予针对性用药，不仅可良好防范并发症，也积极避免了抗生素滥用情况[4]。本次研究针对部分手开放性损伤患者开展了细菌培养与药敏试验，通过与常规应用抗生素患者进行比较，旨在为手开放性损伤患者的临床治疗提供参考建议，现报道如下。