目的:探讨不同手术方案对外伤性脾破裂患者医院感染的影响,为临床降低感染的发生提供参考。方法选取2010年1月-2014年1月于医院进行治疗的1000例外伤性脾破裂患者作为研究对象,按照脾损伤病理分级划分为保脾治疗组435例、全脾切除组384例和脾移植组181例,对保脾治疗组采取保脾手术方案,对全脾切除组采取全脾切除手术方案,对脾移植组采取切除自体脾组织移植术,对比3组患者术后的医院感染情况及术后患者焦虑抑郁状态。结果全脾切除组和脾移植组的患者腹腔内出血,医院感染血栓及栓塞并发症和死亡的状况均比保脾治疗组严重(P<0.05);而全脾切除组与脾移植组相比较,全脾切除组患者的腹腔内出血水平较高(P<0.05);保脾治疗组患者总感染率为2.53%,明显低于全脾切除组和脾移植组的总感染率(P<0.05);对比3组患者术后的焦虑自评量表(SAS)和抑郁自评量表(SDS)的评分结果,保脾治疗组患者的两项评分均低于全脾治疗组和脾移植组(P<0.05)。结论外伤性脾破裂患者术后医院感染与不同手术方案密切相关,尽可能采取保脾手术进行治疗,以改善患者术后心理状态。
OBJECTIVE To explore the influence of different surgery programs on nosocomial infections in the pa‐tients with traumatic splenic rupture so as to reduce the incidence of infections .METHODS A total of 1 000 patients with traumatic splenic rupture who were treated in the hospital from Jan 2010 to Jan 2014 were recruited as the study objects and divided into the spleen‐preserving group with 435 cases ,the total splenectomy group with 384 cases ,and the splenic transplantation group with 181 cases according to pathological grading of splenic injuries . The spleen‐preserving group was treated with the spleen‐preserving surgery ,the total splenectomy group was giv‐en the total splenectomy ,and the splenic transplantation group was treated with autologous splenic tissue trans‐plantation;the prevalence of postoperative nosocomial infections and the state of anxiety and depression were ob‐served and compared between the three groups .RESULTS The abdominal hemorrhage ,thrombosis ,and embolism complications were more severe in the total splenectomy group and the splenic transplantation group than in the spleen‐preserving group ,and the mortality rate of the total splenectomy group and the splenic transplantation group was higher than that of the spleen‐preserving group (P〈0 .05);while the abdominal hemorrhage of the to‐tal splenectomy group was more severe than that of the splenic transplantation group (P〈0 .05) .The total infec‐tion rate of the spleen‐preserving group was 2 .53% ,significantly lower than that of the total splenectomy group and the splenic transplantation group (P〈 0 .05) .As compared with the postoperative self‐rating anxiety scale (SAS) and self‐rating depression scale (SDS) scores between the three groups ,the scores of the spleen‐preserving group were lower than those of the total splenectomy group and the splenic transplantation group (P〈 0 .05) .CONCLUSION The prevalence of postoperative nosocomial infections in the patients with traumati