手术部位感染的可控性风险因素.doc

The Journal of Bone and Joint Surgery (American). 2011;93:398-404.
Modifiable Risk Factors for Surgical Site Infection
手术部位感染的可控性风险因素
Calin S. Moucha, MD1, Terry Clyburn, MD2, Richard P. Evans, MD3 and Laura Prokuski, MD4
1 Department of Orthopaedics, Mount Sinai Medical Center, 5 East 98th Street, Box 1188, New York, NY 10021. E-mail address: mouchacs@
2 Department of Orthopaedic Surgery, University of Texas Medical School at Houston, 6400 Fannin Street, Suite 1700, Houston, TX 77030
3 Department of Orthopaedic Surgery, Shorey #531, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR 72205
4 Sonoran Orthopaedic Trauma Surgeons, 3126 North Civic Center Plaza, Scottsdale, AZ 85251
An Instructional Course Lecture, American Academy of Orthopaedic Surgeons
Introduction
引言
Multiple risk factors for orthopaedic surgical site infection, including a wide variety of demographic, comorbid, operative, and postoperative variables, have been identified1. The patient as a host is an important risk factor for infection, and many, if not most, patients are in suboptimal health. Optimizing the patient's medical condition before surgery and eliminating or even diminishing modifiable risk factors for infection (Fig. 1) should lower the risk of surgical site infection. Direct scientific evidence showing that modification of these risk factors will lead to a decrease in surgical site infection is not readily available, and much work in this field remains to be done. It is imperative that surgeons have an extensive knowledge of modifiable risk factors affecting the wound-healing process and subsequent plications.
目前已经明确,骨科手术部位的感染包括多方面的风险因素,如各种不同的人群、合并症、手术以及术后相关的因素等【1】。患者作为宿主本身就是感染最重要的风险因素,即使不是大多数,那也有很多患者的健康状况并不理想。在手术前将患者的内科情况调整到最佳状态,杜绝或减少感染的可控性风险因素(图1)应该可以降低手术部位感染的风险。然而,对于控制这些风险因素便可减少手术部位感染的观点,要找到直接的科学证据其实并不简单,在这一领域仍有很多工作有待进一步深入。而至关重要的是,外科医生应该对影响创口愈合过程以及继发创口并发症的可控性风险因素有一个全面的认识。
Fig. 1 Modifiable risk factors. Many patients have risk factors