目的 分析骨盆骨折急诊术后感染的危险因素、病原菌特点及诊断指标.方法 选取2019年11月至2022年12月该院收治的393例骨盆骨折急诊手术患者为研究对象,术后发生感染28例为感染组,未发生感染3 6 5例为未感染组.对比分析两组临床特点,检测患者外周血降钙素原(PCT)、中性粒细胞/淋巴细胞比值(NLR)和血小板/淋巴细胞比值(PLR)水平,多因素logistic回归分析影响因素,受试者工作特征(ROC)曲线评估PCT、NLR、PLR对骨盆骨折急诊术后感染的诊断效能.结果 393例骨盆骨折急诊术后有28例患者发生感染,发生率为7.12％(28/393).多因素logistic回归分析结果显示:BMI(OR=2.049)、损伤严重程度评分(ISS,OR=2.439)、手术时间(OR=2.369)、术中失血量(OR=2.781)、合并脑外伤(OR=2.248)、合并腹部损伤(OR=3.469)、合并髋臼骨折(OR=3.109)及合并糖尿病(OR=3.519)是骨盆骨折急诊术后感染的影响因素(P＜0.05).28例感染患者中共培养出30株病原菌,大肠埃希菌、金黄色葡萄球菌及铜绿假单胞菌是常见感染病原菌.感染组患者外周血NLR、PLR、PCT水平高于未感染组(P＜0.05).外周血NLR、PLR、PCT单独诊断骨盆骨折急诊术后感染的曲线下面积(AUC)分别为0.814、0.798、0.856,PLR+NLR、PCT+NLR、PCT+PLR的AUC分别为0.877、0.903、0.857,三者联合诊断效能最高(AUC=0.917).结论 骨盆骨折急诊术后感染的影响因素有BMI、ISS、手术时间、术中失血量、合并脑外伤、合并腹部损伤、合并髋臼骨折及合并糖尿病,大肠埃希菌、金黄色葡萄球菌及铜绿假单胞菌是常见感染病原菌,NLR、PLR、PCT联合检测可用于骨盆骨折急诊术后感染的诊断.
Objective To analyze the risk factors,pathogenic bacteria characteristics and diagnostic in-dexes of infection after emergency operation of pelvic fracture.Methods A total of 393 patients with pelvic fracture emergency operation admitted and treated in this hospital from November 2019 to December 2022 were selected as the study subjects.Twenty-eight patients with postoperative infection served as the infection group,and 365 patients without infection as the non-infection group.The clinical characteristics were com-pared between the two groups and the procalcitonin(PCT),neutrophil/leucocyte ratio(NLR)and platelet/lymphocyte ratio(PLR)levels in peripheral blood of the patients were detected.The multivariate logistic re-gression was used to analyze the influencing factors.The receiver operating characteristic(ROC)curve was a-dopted to evaluated the diagnostic efficiency of PCT,NLR and PLR for infection after pelvic fracture emergen-cy operation.Results Among 393 cases of pelvic fracture emergency operation,infection occurred in 28 cases,with an incidence rate of 7.12％(28/393).The results of multivariate logistic regression analysis showed that BMI(OR=2.049),ISS(OR=2.439),operation time(OR=2.369),intraoperative blood loss volume(OR=2.781),complicating brain trauma(OR=2.248),complicating abdominal injury(OR=3.469),complicating acetabular fracture(OR=3.109)and complicating diabetes mellitus(OR=3.519)were the influencing fac-tors of infection after pelvic fracture emergency operation(P＜0.05).Among 28 cases of infection,30 strains of pathogenic bacteria were cultured.Escherichia coli,Staphylococcus aureus and Pseudomonas aeruginosa were the common pathogenic bacteria of infection.The levels of peripheral blood NLR,PLR and PCT in the infection group were higher than those in the non-infection group(P＜0.05).The areas under the curves(AUC)of peripheral blood NLR,PLR and PCT in diagnosing infection after pelvic fracture emergency opera-tion were 0.814,0.798 and 0.856 respectively.AUC of PLR+NLR,PCT+NLR and PCT+PLR were 0.877,0.903 and 0.857 respectively,and the diagnostic efficiency of the three combination was the highest(0.917).Conclusion The influencing factors of infection after pelvic fracture emergency operation are BMI,ISS,opera-tion time,intraoperative blood loss volume,complicating brain trauma,complicating abdominal injury,compli-cating acetabulum fracture and complicating diabetes mellitus.Escherichia coli,Staphylococcus aureus and pseudomonas aeruginosa are common pathogenic bacteria of infection.The combined detection of NLR,PLR and PCT could be used to the diagnosis of infection after pelvic fracture emergency operation.
刘敏;朱凤
上海交通大学附属第一人民医院护理部,上海 201620
临床医学
骨盆骨折;感染;中性粒细胞/淋巴细胞比值;血小板/淋巴细胞比值;降钙素原
pelvic fracture;infection;neutrophil/lymphocyte ratio;platelet/lymphocyte ratio;procalci-tonin
《重庆医学》 2024 (007)
1009-1015 / 7
10.3969/j.issn.1671-8348.2024.07.009
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