O'Neill Patricia A, Kirton Orlando C, Dresner Lisa S, Tortella Bartholomew, Kestner Mark M
Department of Surgery, SUNY Downstate medical Center and Kings County Hospital Center, Brooklyn, New York 11203,
J Trauma. 2004 Feb;56(2):304-12; discussion 312-3. doi: 10.1097/01.TA.0000109856.25273.07.
Fecal contamination from colon injury has been thought to be the most significant factor for the development of surgical site infection (SSI) after trauma. However, there are increasing data to suggest that other factors may play a role in the development of postinjury infection in patients after colon injury. The purpose of this study was to determine the impact of gastric wounding on the development of SSI and nonsurgical site infection (NSSI) in patients with colon injury.
Post hoc analysis was performed on data prospectively collected for 317 patients presenting with penetrating hollow viscus injury. One hundred sixty-two patients with colon injury were subdivided into one of three groups: patients with isolated colon wounds (C), patients with colon and stomach wounds with or without other organ injury (C+S), and patients with colon and other organ injury but no stomach injury (C-S) and assessed for the development of SSI and NSSI. Infection rates were also determined for patients who sustained isolated gastric injury (S) and gastric injury in combination with other injuries other than colon (S-C). Penetrating Abdominal Trauma Index, operative times, and transfusion were assessed. Discrete variables were analyzed by Cochran-Mantel-Haenszel chi2 test and Fisher's exact test. Risk factor analysis was performed by multivariate logistic regression.
C+S patients had a higher rate of SSI infection (31%) than C patients (3.6%) (p=0.008) and C-S patients (13%) (p=0.021). Similarly, the incidence of NSSI was also significantly greater in the C+S group (37%) compared with the C patients (7.5%) (p=0.07) and the C-S patients (17%) (p=0.019). There was no difference in the rate of SSI or NSSI between the C and C-S groups (p=0.3 and p=0.24, respectively). The rate of SSI was significantly greater in the C+S patients when compared with the S-C patients (31% vs. 10%, p=0.008), but there was no statistical difference in the rate of NSSI in the C+S group and the S-C group (37% vs. 24%, p=0.15).
The addition of a gastric injury to a colon injury has a synergistic effect on the rate of postoperative infection.
结肠损伤导致的粪便污染一直被认为是创伤后手术部位感染（SSI）发生的最重要因素。然而，越来越多的数据表明，其他因素可能在结肠损伤患者的伤后感染发生中起作用。本研究的目的是确定胃损伤对结肠损伤患者手术部位感染和非手术部位感染（NSSI）发生的影响。
对前瞻性收集的317例穿透性中空脏器损伤患者的数据进行事后分析。162例结肠损伤患者被分为三组之一：单纯结肠损伤患者（C组）、伴有或不伴有其他器官损伤的结肠和胃损伤患者（C+S组）、结肠和其他器官损伤但无胃损伤患者（C-S组），并评估手术部位感染和非手术部位感染的发生情况。还确定了单纯胃损伤患者（S组）以及除结肠外合并其他损伤的胃损伤患者（S-C组）的感染率。评估穿透性腹部创伤指数、手术时间和输血情况。离散变量采用Cochran-Mantel-Haenszel卡方检验和Fisher精确检验进行分析。通过多因素逻辑回归进行危险因素分析。
C+S组患者的手术部位感染率（31%）高于C组患者（3.6%）（p=0.008）和C-S组患者（13%）（p=0.021）。同样，C+S组的非手术部位感染发生率（37%）也显著高于C组患者（7.5%）（p=0.07）和C-S组患者（17%）（p=0.019）。C组和C-S组之间的手术部位感染率或非手术部位感染率无差异（分别为p=0.3和p=0.24）。与S-C组患者相比，C+S组患者的手术部位感染率显著更高（31%对10%，p=0.008），但C+S组和S-C组的非手术部位感染率无统计学差异（37%对24%，p=0.15）。
结肠损伤合并胃损伤对术后感染率有协同作用。
