脊柱手术患者术后医院感染的临床特点与影响因素及预防  

Clinical characteristics,risk factors and preventive measures of postoperative nosocomial infection in patients undergoing spinal surgery

作　　者：魏燕[1] 张翠红[1] 谭桃 杨盼盼[1] 沈鑫[1] 冒海敏[1] 马利民[3] WEI Yan;ZHANG Cui-hong;TAN Tao;YANG Pan-pan;SHEN Xin;MAO Hai-min;MA Li-min(Affiliated Hospital of Nantong University,Nantong,Jiangsu 226001,China)

机构地区：[1]南通大学附属医院骨科一病区,江苏南通226001 [2]上海长征医院骨科三病区,上海200003 [3]南通大学附属医院泌尿外科,江苏南通226001

出　　处：《中华医院感染学杂志》2018年第24期3804-3807,共4页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金资助项目(811401056)

摘　　要：目的分析脊柱患者术后医院感染的临床特点和影响因素,探讨预防对策,为降低脊柱手术患者医院感染率提供参考。方法选取医院2013年1月-2018年6月行脊柱手术的患者共计1 200例为研究对象,收集所有患者完整病例资料,回顾性分析术后感染患者自身因素和手术因素,分析所收集的数据并进行统计学处理,分析术后医院感染的影响因素,在研究过程中收集发生感染患者血液、尿液、痰、手术切口分泌物等标本进行病原菌培养,分析患者感染部位分布以及病原菌构成情况。结果我院收治的脊柱手术患者1 200例在术后发生感染共94例,感染率为7.83%;患者感染以肺部感染为主,占总感染的46.81%,切口感染为15.96%,另椎间隙感染6.38%;94例患者取样标本共培养出病原菌98株,其中革兰阳性菌42株,占总培养菌株的42.86%,革兰阴性菌株51株,占总培养菌株的52.04%,真菌5株,占5.10%;多因素Logistic回归分析结果显示,置入材料、手术时间、合并糖尿病及出血量≥1000ml是脊柱手术患者发生术后医院感染的独立影响因素(P<0.05)。结论脊柱手术术后医院感染感染部位以肺部感染、尿路感染为主,病原菌菌株分布广泛,临床医师应当规范手术操作流程,制定预防对策时应当综合考虑,同时应当加强护理工作。OBJECTIVE To analyze the clinical characteristics and influencing factors of postoperative nosocomial infection in patients with spinal diseases,so as to explore preventive measures,and to provide reference for reducing the nosocomial infection rate in patients undergoing spinal surgery.METHODS A total of 1200 patients undergoing spinal surgery in our hospital from Jan.2013 to Jun.2018 were enrolled in this study.Complete clinical data were collected for all patients,the patients’ individual factors and surgical factors were retrospectively analyzed,and the collected data were subjected to statistical analysis.The influencing factors of postoperative nosocomial infection were analyzed.In the course of the study,specimens of patients’ blood,urine,sputum,and incision secretions were collected for culturing of pathogens,and the infection site distribution and pathogen composition were analyzed.RESULTS There were 94 cases of postoperative infections in 1200 patients with spinal surgery.The infection rate was 7.83%.The infections were dominated by lung infection,accounting for 46.81%,followed by incision infection(15.96%)and intervertebral-space infection(6.38%).A total of 98 strains of pathogens were cultivated from the samples of the 94 infected patients,including 42 strains of gram-positive bacteria,accounting for42.86%,51 strains of gram-negative strains,accounting for 52.04%,and 5 strains of fungi,accounting for5.10%.Multivariate Logistic regression analysis showed that implant material,surgical time,diabetes complication and amount of bleeding were independent risk factors for postoperative nosocomial infection in patients undergoing spinal surgery(P<0.05).CONCLUSION Nosocomial infections after spinal surgery were mainly pulmonary infections and urinary tract infections.The strains of pathogens were widely distributed.The risk factors related to infection were mainly surgical related factors.The clinicians should standardize the surgical operation procedure,and comprehensively consider the risk factors when

关 键 词：脊柱手术 医院感染 影响因素 预防对策 

分 类 号：R619.3[医药卫生—外科学]