257例口腔颌面部游离组织皮瓣手术手术部位感染监测

Surveillance on surgical site infection in 257 patients undergoing oralmaxillofacial surgery with microvascular freeflap reconstruction

摘要:

目的了解口腔颌面部游离组织皮瓣手术手术部位感染（SSI）发生情况及其易感因素。方法采用前瞻性调查方法对2010年12月—2011年9月在某院接受口腔颌面部游离组织皮瓣移植修复术的257例患者进行SSI易感因素监测，项目包括年龄、性别、疾病性质、ASA评分、白细胞计数、血红蛋白值、住院天数、手术持续时间、切口类型、术中出血量等。分别在术后1、3、6个月随访3次，跟踪调查不同时段SSI发生情况。结果257例患者发生SSI 46例（17.90%），均为深部切口感染；其中19例（41.30%）感染发生在住院期间，27例（58.70%）为出院后随访发现的感染，供区未发生感染。感染发生时间为术后5～34 d，中位数为11 d。易感因素监测中除骨组织皮瓣手术术中抗菌药物给药时间（术中≤110 min给药）有统计学意义（P＜0.05），其他因素均无统计学意义（P＞0.05）。结论口腔颌面部游离组织皮瓣手术SSI发生率较高，且较多发生在出院后，临床应重视，加强术后随访；同时针对易感因素进行干预，合理使用抗菌药物，有效降低SSI的发生。

Abstract:

ObjectiveTo investigate the occurrence and susceptibility factors of surgical site infection(SSI) in patients undergoing oralmaxillofacial surgery with microvascular freeflap reconstruction.MethodsFrom December 2010 to September 2011, a prospective survey was performed to monitor the susceptibility factors for SSI in 257 patients undergoing oralmaxillofacial surgery with microvascular freeflap reconstruction, the surveyed contents  included age, sex, the nature of disease, American Society of Anesthesiologists(ASA) score, white blood cell, hematoglobin, length of hospital stay, length of surgery, types of incision, intraoperative blood loss and so on. Patients were followed up after  1, 3 and 6 months of operation,the occurrence of SSI at different stages were surveyed.ResultsOf 257 patients, 46 (17.90%) developed SSI, and all were deep wound infection,19 (41.30%) of whom had SSI during hospitalization period, and 27 (58.70%) were found through postdischarge followup investigation. Infection occurred 5-34 days  after  operation, the median time was 11 day. Monitoring of susceptibility factors showed that,except  the duration of intraoperative antimicrobial use  (≤110 min) was statistically significant (P<0.05), other factors were not statistically significant (P>0.05).ConclusionIncidence of SSI is high  in oralmaxillofacial surgery with microvascular freeflap reconstruction, and mostly  occur in patients after discharging from  hospital. In order to reduce SSI effectively, clinical attention should be paid, postoperative followup should be intensified, intervention in susceptibility factors should be performed, and antimicrobial agents should be used rationally.