CAJ | 학술논문

目的：探讨不同手术方案对外伤性脾破裂患者医院感染的影响，为临床降低感染的发生提供参考。方法选取2010年1月－2014年1月于医院进行治疗的1000例外伤性脾破裂患者作为研究对象，按照脾损伤病理分级划分为保脾治疗组435例、全脾切除组384例和脾移植组181例，对保脾治疗组采取保脾手术方案，对全脾切除组采取全脾切除手术方案，对脾移植组采取切除自体脾组织移植术，对比3组患者术后的医院感染情况及术后患者焦虑抑郁状态。结果全脾切除组和脾移植组的患者腹腔内出血，医院感染血栓及栓塞并发症和死亡的状况均比保脾治疗组严重（P＜0．05）；而全脾切除组与脾移植组相比较，全脾切除组患者的腹腔内出血水平较高（P＜0．05）；保脾治疗组患者总感染率为2．53％，明显低于全脾切除组和脾移植组的总感染率（P＜0．05）；对比3组患者术后的焦虑自评量表（SAS）和抑郁自评量表（SDS）的评分结果，保脾治疗组患者的两项评分均低于全脾治疗组和脾移植组（P＜0．05）。结论外伤性脾破裂患者术后医院感染与不同手术方案密切相关，尽可能采取保脾手术进行治疗，以改善患者术后心理状态。
목적：탐토불동수술방안대외상성비파렬환자의원감염적영향，위림상강저감염적발생제공삼고。방법선취2010년1월－2014년1월우의원진행치료적1000예외상성비파렬환자작위연구대상，안조비손상병리분급화분위보비치료조435례、전비절제조384례화비이식조181례，대보비치료조채취보비수술방안，대전비절제조채취전비절제수술방안，대비이식조채취절제자체비조직이식술，대비3조환자술후적의원감염정황급술후환자초필억욱상태。결과전비절제조화비이식조적환자복강내출혈，의원감염혈전급전새병발증화사망적상황균비보비치료조엄중（P＜0．05）；이전비절제조여비이식조상비교，전비절제조환자적복강내출혈수평교고（P＜0．05）；보비치료조환자총감염솔위2．53％，명현저우전비절제조화비이식조적총감염솔（P＜0．05）；대비3조환자술후적초필자평량표（SAS）화억욱자평량표（SDS）적평분결과，보비치료조환자적량항평분균저우전비치료조화비이식조（P＜0．05）。결론외상성비파렬환자술후의원감염여불동수술방안밀절상관，진가능채취보비수술진행치료，이개선환자술후심리상태。
OBJECTIVE To explore the influence of different surgery programs on nosocomial infections in the pa‐tients with traumatic splenic rupture so as to reduce the incidence of infections .METHODS A total of 1 000 patients with traumatic splenic rupture who were treated in the hospital from Jan 2010 to Jan 2014 were recruited as the study objects and divided into the spleen‐preserving group with 435 cases ,the total splenectomy group with 384 cases ,and the splenic transplantation group with 181 cases according to pathological grading of splenic injuries . The spleen‐preserving group was treated with the spleen‐preserving surgery ,the total splenectomy group was giv‐en the total splenectomy ,and the splenic transplantation group was treated with autologous splenic tissue trans‐plantation;the prevalence of postoperative nosocomial infections and the state of anxiety and depression were ob‐served and compared between the three groups .RESULTS The abdominal hemorrhage ,thrombosis ,and embolism complications were more severe in the total splenectomy group and the splenic transplantation group than in the spleen‐preserving group ,and the mortality rate of the total splenectomy group and the splenic transplantation group was higher than that of the spleen‐preserving group (P<0 .05);while the abdominal hemorrhage of the to‐tal splenectomy group was more severe than that of the splenic transplantation group (P<0 .05) .The total infec‐tion rate of the spleen‐preserving group was 2 .53% ,significantly lower than that of the total splenectomy group and the splenic transplantation group (P< 0 .05) .As compared with the postoperative self‐rating anxiety scale (SAS) and self‐rating depression scale (SDS) scores between the three groups ,the scores of the spleen‐preserving group were lower than those of the total splenectomy group and the splenic transplantation group (P< 0 .05) .CONCLUSION The prevalence of postoperative nosocomial infections in the patients with traumatic spenic rupture is closely associated with the different surgery programs ,and the spleen‐preserving surgery should be taken as the preferred option so as to improve the postoperative psychological state of the patients .