| Objective:1. To investigate a three A-level general hospital open wound extremities injury patients'distribution of the original bacteria to explore the different factors of the wound-positive detection rate of pathogenic bacteria and the number of detected pathogen bacteria. Through investigation to find the distribution of the characteristics of wound pathogens, in ordor to provide a reasonable basis of the use of preventive anti-infective drugs for clinical doctors.2. Detecting and analyzing the IL-6, TNF-αlevel of a three A-level general hospital patients with open wound extremities to explore post-traumatic stress response in patients'immune status, analyze the different factors impact on the IL-6, TNF-αserum the level, and know about different periods of post-traumatic the degree of change in IL-6, TNF-αserum level, in order to conduct clinical immunomodulatory therapy. Methods:1. Detecting the wound pathogen bacteria and IL -6, TNF-αserum level of those open wound extremities injury patients who hospitalized in the orthopedic intensive care unit or the NO.2 orthopedic ward through the emergency room during the period of April 2009 to September .Those pathogen bacteria samples were got on the time just before and after the debridement and the serum samples were got on the moment and the fifth day of admission.229 pathogen bacteria samples were got before the debridement and 152 were got after that (77 patients were not hospitalized).124 serum samples were got when the patients were admitted, and 86 samples were got on the fifth day of hospitalization, including 72 self-paired samples. SPSS 16.0 statistical software were used to descripe and analyze the pathogen bacteria detection results and the serum test results of IL -6, TNF-α.2. According to gender, age time between trauma and admiddion,trauma types,fracture or not ,break away or not,single/multi-site injuries and other factors to distribute the cases into different groups,to state the impact of those factors on the pathogen bacteria detection positive rate,and using Qne-way ANOVA to analyze the impact of the factors on the number of pathogen bacteria,those lose the homogeneity of variance test were analyzed by Kruskal-Wallis test.3. According to gender,age,time between trauma and admission,time between trauma and opetation,operation time, wound type, fractureor not , break away or not,single/multi-site injuries and other factors, using multiple linear regression test to analyze the impact of those factors on the IL -6, TNF-αserum level of the moment of admission and the fifth day of hospitalization, using paired-samples t test to analyze the change of IL -6, TNF-αserum level of those 72 self-paired samples,and using multiple linear regression test to analyze the impact of those factors on the IL -6, TNF-αserum level for the self-paired samples to find the relative factors.4. Using multiple linear regression tests to analyze the impact of the positive rate of pathogen bacteria detective results on the serum level of IL -6, TNF-α.Results:1. 229 patients with open wound extremities injury were admitted from emergency room from April 2009 to September.We had got 229 samples of pathogen bacteria before debriment wich detected bacteria 15 types, 255 cases in all; 152 samples of pathogen bacteria after debriment which detected bacteria 3 types ,3 cases in all. There were 147 cases bacteria detected positive with a rate of 64.2%.According to different factors,χ2 test were used .The results showed that the bacteria positive rate of multi-site wounds was higher than those single-site wound(P<0.05),and the bacteria positive rate of patients who admitted less than 6 hours was less than those more than 6 hours(P<0.05).2.Retrospective investigating the infection pathogen bacteria of those infectious patients who were hospitalize in the orthopedic wards.The results showed that the main infectious bacteria was G- bacteria,while the 229 samlples told us the pathogen bacteria was mainly G+ bacteria.3. We got serum samples 124 cases when patients admitted, 86 cases on the fifth day of hospitalization, including 72 self-paried cases.Through the multiple linear regression test wo found that gender, age, time betweem trauma and admission, wound site, wound type, single/multi-site wound, fracture or not, break away or not, and et al had nonsense in the impact of the IL -6, TNF-αserum level when admission;time between trauma and admission, fracture or not , hospitalizing ward could significantly impact on the IL -6 serum level on the fifth day of hospitalization(P<0.05); fracture or not ,break away or not could impact the TNF-αserum level on the fifth day of hospitalization(P<0.05); fracture or not could highly impact the change of IL -6 serum level between the admission and the fifth day of hospitalization(P<0.05); and the admitting wards could significantly impact the change of TNF-αserum level between the admission and the fifth day of hospitalization(P<0.05).Any other factors had no statistical meanings to those indicators(P>0.05).4. The results of the multiple linear regression test showd that the positive rate of pathogen bactetia did not impact the serum level of IL -6, TNF-α(P>0.05).5.The paired-samples t test analyzed the serum level of IL -6, TNF-αfor the 72 self-paired samples which told us that there on difference between the moment of admission and the fifth day of hospitalization (P>0.05)Conclusions:The pathogen bacteria is mainly G+ bacteria in those open wound extremities injury patients.Doctors can chose some antibiotic drugs to preventive anti G+ bacteria.More than 6 hours post-trauma the positive rate and type number of the pathogen bacteria can become higher .It is very important to take the debriment in 6 hours after the trauma.Different immune indicators have different impact factors.Putting emphasis on the detection of the change of those immune factors and the impact of the prognosis interact with the situation of wounds to take regulately immune therapy treatment.There are signidicant meanings in improving the prognosis of patients,reducing infection rates,reducing patient'economic burden,reducing medical waste and improving the qualities of care.
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