| 梁显南,颜 帅,吉家聪,陈新龙,井 刚,王玉珏.四肢深度烧伤患者创面感染的病原菌分布、危险因素分析及血清促炎因子水平变化的临床意义[J].,2022,(16):3143-3147 |
| 四肢深度烧伤患者创面感染的病原菌分布、危险因素分析及血清促炎因子水平变化的临床意义 |
| Pathogenic Bacteria Distribution, Risk Factors Analysis and Clinical Significance of Serum Proinflammatory Factors in Patients with Deep Burn of Limbs |
| 投稿时间：2022-03-06 修订日期：2022-03-30 |
| DOI：10.13241/j.cnki.pmb.2022.16.029 |
| 中文关键词: 四肢深度烧伤 创面感染 病原菌分布 危险因素 促炎因子 |
| 英文关键词: Deep burn of limbs Wound infection Pathogen distribution Risk factors Proinflammatory factors |
| 基金项目:国家自然科学基金项目（81402617）；海南省卫生计生行业科研项目（19A200134） |
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| 中文摘要: |
| 摘要 目的：观察四肢深度烧伤患者创面感染的病原菌分布特点，并分析感染的危险因素及血清促炎因子水平变化的临床意义。方法：回顾性分析2018年3月~2021年1月期间海南省第三人民医院烧伤整形科收治的220例四肢深度烧伤患者的病例资料，根据是否发生创面感染分为感染组和未感染组，观察感染组创面分泌物病原菌分布特点，收集相关资料，分析创面感染的危险因素，比较感染组和未感染组血清血清促炎因子水平的差异。结果：220例四肢深度烧伤患者中，有64例出现创面感染，感染率为29.09%。64例感染患者中共检出102株病原菌，革兰阴性菌占比67.65%（69/102），其中铜绿假单胞菌（52.94%）、鲍氏不动杆菌（7.84%）、大肠埃希菌（2.94%）排前三位；革兰阳性菌占比32.35%（33/102），其中金黄色葡萄球菌（14.71%）、表皮葡萄球菌（7.84%）排前两位；无真菌检出。单因素分析结果显示：四肢深度烧伤患者是否发生创面感染与术后有无残余创面、是否合并糖尿病、烧伤面积、是否存在吸入性损伤、住院时长、烧伤深度有关（P<0.05），而与年龄、性别、烧伤部位、烧伤原因无关（P>0.05）。多因素Logistic回归分析结果显示：术后有残余创面、合并糖尿病、烧伤面积≥40%、存在吸入性损伤、烧伤深度为III度是四肢深度烧伤患者发生创面感染的危险因素（P<0.05）。感染组的血清超敏C反应蛋白（hs-CRP）、白介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）水平高于未感染组（P<0.05）。结论：四肢深度烧伤患者发生创面感染概率较高，且感染者的炎性反应更为剧烈，创面感染受到多种因素影响，创面感染的病原菌以铜绿假单胞菌和金黄色葡萄球菌为主，临床应及早干预并选用合适的抗菌药物。 |
| 英文摘要: |
| ABSTRACT Objective: To observe the pathogenic bacteria distribution of wound infection in patients with deep burn of limbs, and to analyze the risk factors of infection and the clinical significance of the changes of serum proinflammatory factors levels. Methods: The clinical data of 220 patients with deep burn of limbs who were admitted to the Department of Burn and Plastic Surgery, Hainan Third People's Hospital from March 2018 to January 2021 were retrospectively analyzed. According to whether wound infection occurred, they were divided into infected group and non-infected group. The distribution characteristics of pathogenic bacteria in wound secretion of infected group were observed, and relevant data were collected. To analyze the risk factors of wound infection, and the levels of serum proinflammatory factors in infected group and uninfected group were compared. Results: Among 220 patients with deep burn of limbs, 64 cases had wound infection, and the infection rate was 29.09%. A total of 102 strains of pathogenic bacteria were detected from 64 infected patients.Gram negative bacteria accounted for 67.65% (69/102), among which Pseudomonas aeruginosa (52.94%), Acinetobacter baumannii (7.84%) and Escherichia coli (2.94%) ranked among the top three. Gram positive bacteria accounted for 32.35% (33/102), among which Staphylococcus aureus (14.71%) and Staphylococcus epidermidis (7.84%) were the top two. No fungi were detected. Univariate analysis showed that wound infection in patients with deep burn wounds was associated with postoperative residual wounds, whether diabetes mellitus, burn area, inhalation injury, length of stay and burn depth(P<0.05), but not related to age, gender, burn site and burns reason(P>0.05). Multivariate Logistic regression analysis showed that residual wound, complicated with diabetes, burn area of more than 40%, inhalation injury and burn depth of III degrees were all risk factors for wound infection in patients with deep burn wounds after operation(P<0.05). Serum high-sensitivity C-reactive protein (hs-CRP), interleukin-6(IL-6), tumor necrosis factor- α (TNF-α) level in the infection group were higher than those in the uninfected group(P<0.05). Conclusion: The incidence of wound infection in patients with deep burn of limbs is high, and the incidence of infection is related to many factors. The pathogenic bacteria of wound infection are pseudomonas aeruginosa and Staphylococcus aureus, so early intervention and appropriate antibiotics should be used in clinic. |
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