神经外科手术患者医院感染目标性监测分析  

Targeted surveillance of nosocomial infections in neurosurgery department patients

作　　者：吴琛[1] 冯薇[1] 乔美珍[1] 刘月秀[1] 吴旭琴[1] 金美娟[1] 

机构地区：[1]苏州大学附属第一医院感染管理科,江苏苏州215006

出　　处：《中华医院感染学杂志》2014年第7期1742-1744,共3页Chinese Journal of Nosocomiology

基　　金：江苏省苏州市科技计划基金资助项目(2012SYS60);江苏省苏州市科技计划基金项目(2003SZD0344)

摘　　要：目的分析神经外科手术患者术后医院感染相关危险因素,探讨预防控制对策以降低医院感染率。方法目标性监测2011年5月-2012年11月神经外科住院择期和急诊的脑肿瘤、脑积水、颅骨修补、脊髓疾病等疾病1 862例实施手术患者临床资料,分析结果反馈临床,提出干预对策,采用SPSS15.0软件进行数据分析。结果神经外科1 862例手术患者发生医院感染222例、249例次,感染率11.32%、例次感染率13.37%;其中脑肿瘤术后感染率15.83%,脑积水分流术后感染率11.83%;感染部位以下呼吸道为主占42.97%,其次为颅内占41.37%、泌尿道12.45%;分离出病原菌149株,前3位为肺炎克雷伯菌、铜绿假单胞菌、金黄色葡萄球菌,分别占18.79%、14.77%、10.74%;单因素分析和logistic回归分析显示,年龄、手术时间、手术类型、伤口清洁度、术前外周白细胞数、气管切开、颅内置管、植入物、预防应用抗菌药物和住院时间是主要独立危险因素。结论神经外科手术后医院感染率较高,应尽量缩短住院天数和手术时间,加强急诊手术和无菌物品管理,严格执行无菌操作,合理使用抗菌药物,加强手术患者的全程管理。OBJECTIVE To analyze the risk factors of nosocomial infections in neurosurgery patients in order to reduce the incidence of it .METHODS The prospective monitoring was performed in the neurosurgery department and emergency treatment from May 2011 to Nov .2012 to a total of 1862 patients with brain tumor ,hydroceph-alus ,cranioplasty ,and spinal cord disease .The results were feed back to clinic and measures were provided . SPSS15 .0 software was used for data analysis .RESULTS The 222 patients（249 case-times） of nosocomial infec-tions were occurred in 1 862 cases ,with the infection rate of 11 .92% （the case-time infection rate of 13 .37% ）;the brain tumor incidence of postoperative infection was first at 15 .83% ,and hydrocephalus shunt infection was second at 11 .83% ;the lower respiratory tract infection was the mainly section （at 42 .97% ） ,and the intracranial infection（41 .37% ） ,urinary tract （12 .45）% .A total of 149 strains of pathogens were isolated ,the top three were K lebsiella pneumoniae ,Pseudomonas aeruginosa and Staphylococcus aureus ,accounting for 18 .79% ,14 .77%and 10 .74% respectively ;the single factor analysis and logistic analysis of regression showed that age ,operation duration ,types of surgery ,sterile of blade ,white cell account before the operation ,tracheotomy ,set of the suction tube ,use of implants ,antibiotics used for prevention and the time of the hospital stay were the mainly independent risk factors .CONCLUSION The incidence of nosocomial infections in neurosurgery department is higher .Therefore ,it must be strengthened that minimizing the hospital stay and operating duration ,managing the emergency operation and sterile materiel ,and using antibiotics rationally ,strengthening the management of whole stay hospitalized .

关 键 词：神经外科 手术患者 医院感染 目标性监测 

分 类 号：R181.32[医药卫生—流行病学]