张智轶 安峰 卢成 赵亭亭 胥爱文

[摘要]目的：分析口腔正畸治療中发生伤口感染的相关危险因素，并探究感染患者病原菌分布及耐药情况。方法：选取2018年6月-2019年12月笔者医院收治的口腔正畸治疗中出现口腔伤口感染的80例患者为感染组，同时选取同期口腔正畸治疗中未出现口腔伤口感染的55例患者为未感染组。收集患者一般资料，分析患者正畸治疗中口腔伤口感染的危险因素，检测感染患者病原菌分布及耐药情况，并比较两组患者口腔分泌液中相关细胞因子（骨桥蛋白、胰岛素样生长因子及Fascin蛋白）水平。结果：Logistic回归分析发现，喜甜、硬食、有龋齿是引发口腔伤口感染的独立危险因素，刷牙时间（≥3分钟/次）是独立保护因素（P<0.05）。80例感染患者取样分离病原菌95株，其中革兰阴性菌56株，占比58.95%，革兰阳性菌39株，占比41.05%。主要病原菌牙龈卟啉单胞菌对阿米卡星和亚胺培南敏感，肺炎克雷伯菌仅对头孢他啶、亚胺培南敏感，口腔链球菌对万古霉素敏感。感染组患者口腔分泌液中骨桥蛋白、胰岛素样生长因子及Fascin蛋白水平均低于未感染组，差异具有统计学意义（P<0.05）。结论：口腔正畸治疗中发生口腔伤口感染后组织修复相关因子水平降低，病原菌以革兰阴性菌为主，其中喜甜、硬食，有龋齿是引发牙伤口感染的独立危险因素，刷牙时间（≥3分钟/次）是独立保护因素，应引起高度重视。

[关键词]口腔;正畸;口腔伤口感染;危险因素;保护因素;病原学

[中图分类号]R783.5    [文献标志码]A    [文章编号]1008-6455（2021）06-0146-05

Related risk Factors and Etiology Analysis of Oral Wound Infection During Orthodontics

ZHANG Zhi-yi1， AN Feng1， LU Cheng2， ZHAO Ting-ting1， XU Ai-wen1

（1.Department of Stomatology; 2.Department of Microbiology，the First Affiliated Hospital of Hebei North University，Zhangjiakou 075061，Hebei，China）

Abstract： Objective  To analyze the related risk factors of oral wound infection during orthodontics， and to explore the distribution and drug resistance of pathogenic bacteria in patients with infection. Methods  During the period from June 2018 to December 2019， 80 patients with oral wound infection during orthodontics in the hospital were enrolled as infection group while another 55 patients without oral wound infection during the same period were enrolled as non-infection group. The general data of patients were collected. The risk factors of oral wound infection during orthodontics were analyzed. The distribution and drug resistance of pathogenic bacteria were detected among patients with infection. The levels of related cytokines （osteopontin， insulin-like growth factor， Fascin protein） in oral secretions were compared between the two groups. Results  It was found by Logistic regression analysis that preferences for sweet food and hard food and dental caries were independent risk factors of oral wound infection while tooth brushing time （not shorter than 3min/once） was an independent protective factor （P<0.05）. Among the 80 patients with infection， there were 95 strains of pathogenic bacteria， including 56 strains of Gram-negative bacteria （58.95%） and 39 strains of Gram-positive bacteria （41.05%）. The main pathogen Porphyromonas gingivalis was sensitive to Amikacin and Imipenem. Klebsiella pneumoniae was only sensitive to Ceftazidime and Imipenem， and Streptococcus oralis was sensitive to Vancomycin. The levels of osteopontin， insulin-like growth factor and Fascin in oral secretions of infection group were lower than those of non-infection group （P<0.05）. Conclusion  During orthodontics， the levels of tissue repair-related factors decrease after oral wound infection. The pathogenic bacteria are mainly Gram-negative bacteria. Preferences for sweet food and hard food and dental caries are independent risk factors of oral wound infection while tooth brushing time （not shorter than 3min/once） is an independent protective factor， which should be highly attached to.

Key words： oral cavity; orthodontics; oral wound infection; risk factors; protective factors; etiology

近年来，口腔卫生已经成为社会关注的重点问题之一。阻生牙是指牙齿生长位置不正确，无法萌出到正常咬合位置，极大地影响患者的外貌及身心健康[1]。目前，临床上普遍采用正畸牵引治疗改善症状，口腔正畸治疗主要是通过持续轻柔并且正确的力作用在牙齿上，通过牙周组织的改建使牙齿缓慢移动到正确的位置上，且要求牙齿在牙槽窝中移动时不对牙齿本身及其支持组织造成损伤，不引起任何病理变化[2-3]。但在进行口腔正畸治疗过程中，患者使用器材，如：托槽、弓丝、结扎丝等较易受到污染，属于潜在感染源，而治疗过程中手术操作及器械可能损伤患者口腔黏膜，且口腔环境湿润，适合病原微生物生长，故正畸治疗易造成患者炎症及感染。……