CAJ | 학술논문

目的比较应用负压封闭引流(VSD)和常规换药两种方法处理开放性骨折后其创面细菌学的变化.方法回顾性分析2010年10月至2013年7月期间收治的121例开放性骨折且术后发生感染的患者资料,男88例,女33例;年龄为4 ～ 75岁,平均39.9岁;受伤至入院时间为1～16h,平均6.0h.所有患者入院后均急诊行清创及内固定、外固定或截肢术,根据术后伤口处理方法的不同将患者分成两组:VSD组60例,男45例,女15例;平均年龄为(40.6±17.0)岁,术后伤口应用VSD持续创面引流;换药组61例,男43例,女18例;平均年龄为(37.3±13.4)岁,术后创面常规换药处理.分别取两组患者的感染创面分泌物行细菌培养加药敏试验,比较其创面的细菌学结果.结果 VSD组60例患者分离出60株细菌,共8种病原菌.换药组61例患者分离出69株细菌,共11种病原菌.两组患者术后感染细菌多为革兰阴性菌[VSD组占83.3％ (50/60),换药组占91.3％ (63/69)];鲍曼不动杆菌是主要致病菌[VSD组为36.7％ (22/60),换药组为49.3％ (34/69)].VSD组多重耐药菌感染率为20.0％ (12/60),换药组为60.9％ (42/69),两组比较差异有统计学意义(P＜0.05).多重耐药菌中仍以鲍曼不动杆菌为主[VSD组占83.3％ (10/12),换药组占81.0％ (34/42)],其对头孢哌酮/舒巴坦的耐药率相对较低[VSD组为9.1％ (2/22),换药组为44.1％ (15/34),两组比较差异有统计学意义(P＜0.05)].结论导致开放性骨折感染的病原菌以革兰阴性菌为主,创面行VSD能明显降低多重耐药菌的感染率.
목적 비교응용부압봉폐인류(VSD)화상규환약량충방법처리개방성골절후기창면세균학적변화.방법 회고성분석2010년10월지2013년7월기간수치적121례개방성골절차술후발생감염적환자자료,남88례,녀33례;년령위4 ～ 75세,평균39.9세;수상지입원시간위1～16h,평균6.0h.소유환자입원후균급진행청창급내고정、외고정혹절지술,근거술후상구처리방법적불동장환자분성량조:VSD조60례,남45례,녀15례;평균년령위(40.6±17.0)세,술후상구응용VSD지속창면인류;환약조61례,남43례,녀18례;평균년령위(37.3±13.4)세,술후창면상규환약처리.분별취량조환자적감염창면분비물행세균배양가약민시험,비교기창면적세균학결과.결과 VSD조60례환자분리출60주세균,공8충병원균.환약조61례환자분리출69주세균,공11충병원균.량조환자술후감염세균다위혁란음성균[VSD조점83.3％ (50/60),환약조점91.3％ (63/69)];포만불동간균시주요치병균[VSD조위36.7％ (22/60),환약조위49.3％ (34/69)].VSD조다중내약균감염솔위20.0％ (12/60),환약조위60.9％ (42/69),량조비교차이유통계학의의(P＜0.05).다중내약균중잉이포만불동간균위주[VSD조점83.3％ (10/12),환약조점81.0％ (34/42)],기대두포고동/서파탄적내약솔상대교저[VSD조위9.1％ (2/22),환약조위44.1％ (15/34),량조비교차이유통계학의의(P＜0.05)].결론 도치개방성골절감염적병원균이혁란음성균위주,창면행VSD능명현강저다중내약균적감염솔.
Objective To compare the bacteriological changes at the infected wounds of open fracture after management with vacuum sealing drainage (VSD) and traditional dressing change.Methods We retrospectively reviewed the 121 patients who had been treated for open fractures at our institute but inflicted with wound infection after emergency surgery from October 2010 to July 2013.They were 88 males and 33 females,aged from 4 to 75 years (average,39.9 years).The interval from injury to admission ranged from 1 to 16 hours (average,6.0 hours).They underwent internal or external fixation or amputation after emergent debridement.They were divided into 2 groups according to the wounds management following emergency surgery.In group A where VSD was used for management of the wounds,there were 45 males and 15 females,with an average age of 40.6 ± 17.0 years.In group B where traditional dressing change was used,there were 43 males and 18 females,with an average age of 37.3 ± 13.4 years.Culture results of strains and drug sensitivity of the bacteria sampled from the infected wound were compared between the 2 groups.Results In group A of 60 patients,60 strains of 8 kinds were isolated; in group B of 61 patients,69 strains of 11 kinds were isolated.The majority of pathogenic bacteria in the 2 groups were gram-negative bacteria [83.3％ (50/60) in group A versus 91.3％ (63/69) in group B].Acinetobacter baumannii was the main pathogenic bacteria [36.7％ (22/60) in group A versus 49.3％ (34/69) in group B].The infection rate of multi-drug resistant bacteria (MDR) was 20.0％ (12/60) in group A and 60.9％ (42/69) in group B,with a significant statistical difference between the 2 groups (P ＜ 0.05).Acinetobacter baumannii still accounted for a chief proportion of MDR [83.3％ (10/12) in group A versus 81.0％ (34/42) in group B].The drug resistance of Acinetobacter baumannii to cefoperazone sulbactam was 9.1％ in group A (2/22) and 44.1％ in group B (15/34),with a significant statistical difference between the 2 groups (P ＜ 0.05).Conclusions The majority of pathogenic bacteria for open fractures are gram-negative bacteria.VSD may significantly reduce the infection rate of MDR in open fractures.