肛肠外科手术患者医院感染的危险因素与预防对策  

Risk factors and treatment of nosocomial infections in patients after anorectal surgery

作　　者：张杰[1] 曹彩琴[1] 吴静[1] 

机构地区：[1]武汉科技大学附属天佑医院介入科,湖北武汉430064

出　　处：《中华医院感染学杂志》2014年第3期695-697,共3页Chinese Journal of Nosocomiology

基　　金：湖北省卫生厅科研基金资助项目(JX6B-20)

摘　　要：目的分析肛肠手术患者发生医院感染的危险因素,以采取有针对性诊疗措施,为临床诊治提供借鉴。方法对2010年1月-2012年12月行肛肠疾病手术的597例患者临床资料进行分析,研究其医院感染发生的危险因素。结果 597例肛肠手术患者中发生医院感染93例,感染率为15.58%;感染常见部位为切口感染46例占49.46%、呼吸道16例占17.20%、泌尿道15例占16.13%、胃肠道12例占12.90%;分离出革兰阴性杆菌56株占60.22%,革兰阳性球菌24株占25.81%,真菌11株占11.83%;单因素分析,医院感染与年龄、肥胖、病程、手术时间、抗菌药物种类有相关性,logistic多因素回归分析发现,年龄(OR=2.373,P=0.015)、肥胖(OR=2.837,P=0.013)、手术时间(OR=2.721,P=0.013)和抗菌药物种类(OR=2.702,P=0.019)是医院感染发生的独立危险因素。结论肛肠手术患者医院感染发生率较高,影响其发生的因素多种多样,应采取有针对性的诊疗措施,密切监测高龄患者,加强手术室及手术部位消毒,熟练掌握手术操作技能,合理应用抗菌药物,降低医院感染的发生。OBJECTIVE To explore the risk factors of nosocomical infections in patients after anorectal surgery, in order to use targeting treatment and privide scienific basis for the effective diagnosis and treatment. METHODS The clinical data from 597 inpatients with anoreetal surgery from Jan. 2010 to Dec. 2012 were analysed for figuring out the risk factors of nosocomial infections. RESULTS There were 93 cases with nosocomial infection in 597 patients after anorectal surgery, the infection rate was 15. 58%. The main infection sites were incision infection 46 cases（49.46%） ,respiratory tract 16 cases（17.20%）, urinary tract 15 eases（16.13%）, and digestive tract 12 cases（12.90 %）;major pathogens were gram-negative bacteria 56 cases（60.22 %）, gram positive cocci 24 cases（25.81 %） and fungal infections 11 cases （11.83 %） ; in single factor analysis, the nosocomial infections in patient with anorectal disease were closely associated with age, obesity, course of disease, operation time, species of antibiotics usage, and after logistic regression analysis, we knew that age （OR = 2. 373, P = 0. 015）, obesity （OR=2.837,P=0. 013）, operation time （OR=2. 721, P=0. 013） and species of antibiotics usage（OR=2. 702, P=0. 019）were the independent risk factors causing nosocomieal infections. CONCLUSION The incidence of anorectal disease with hospital infection is high, which is influenced by many factors. More targeting diagnosis and treatment measures should be taken. The elderly patients should be closely monitored. The operation circumstance and surgery sections should be disinfected. The improvement of surgery skills and rationally using of antibacterial agents should be enhanced to reduce the incidence of hospital infections.

关 键 词：肛肠手术 医院感染 危险因素 

分 类 号：R181.32[医药卫生—流行病学]