神经外科患者手术部位感染及危险因素  

Surgical site infection and risk factors of neurosurgical patients

作　　者：付菊芳[1] 杨志芳[1] 程瑶[1] 张瑞娜[1] 刘冰[1] 史皆然[1] 张永琴[1] 戴丽文[1] 

机构地区：[1]第四军医大学西京医院,陕西西安710032

出　　处：《中国感染控制杂志》2016年第5期304-308,共5页Chinese Journal of Infection Control

基　　金：陕西省自然科学基金项目(2014JM2-8149);中华医院感染控制研究基金(ZHYY2013-014)

摘　　要：目的了解某三甲医院神经外科手术部位感染(SSI)发病率及其危险因素,为预防SSI提供理论依据。方法将该院神经外科2011年12月31日—2012年12月31日发生SSI的47例患者(共49例,其中2例未配比合适对照患者,故舍去)设为感染组,未发生SSI的94例患者(1∶2配比)设为非感染组,采用回顾性调查分析方法,对SSI相关危险因素进行分析。结果两组患者一般情况比较,差异均无统计学意义(均P>0.05);3 708例手术患者,发生SSI 49例,SSI发病率为1.32%;SSI以颅内感染为主(89.80%);49例SSI患者共27例行脑脊液细菌学检测,其中6例患者脑脊液细菌学检测阳性,病原菌检出率为22.22%。单因素条件logistic分析显示:手术风险评估分级(OR=2.04)、术前抗菌药物使用次数(OR=3.15)、术中抗菌药物使用次数(OR=2.58)、手术持续时间(OR=2.70)、术中失血量(OR=1.72)、留置引流管(OR=4.30)、术后置管持续时间(OR=2.06)及术后首次换药时间(OR=1.66)为神经外科SSI危险因素;多因素条件logistic回归分析显示:术前抗菌药物使用次数(P=0.03,OR=4.86)、手术持续时间(P=0.05,OR=2.89)及术后首次换药时间(P=0.01,OR=1.92)是SSI的独立危险因素。结论神经外科SSI危险因素多,手术持续时间、术后置管持续时间及术后首次换药时间是主要危险因素。Objective To investigate the incidence and risk factors of surgical site infection（SSI）in neurosurgical patients in a tertiary first-class hospital,and provide reference for the prevention and control of SSI.Methods 47 neurological patients with SSI（49 patients developed SSI,2 were excluded from study due to the lack of appropriate control subject）from December 31,2011 to December 31,2012 were as infected group,and 94 patients without SSI（1∶2 matching）were as non-infected group,risk factors for SSI were analyzed retrospectively.Results There was no significant difference in general condition of two groups of patients（all P〈0.05）;among 3 708 patients,49（1.32%）developed SSI;intracranial infection was the main type of SSI（89.80%）;27 patients were performed cerebrospinal fluid（CSF）bacteriological detection,6（22.22%）of whom were positive for CSF bacteriological detection.Univariate conditional logistic regression analysis showed that risk factors for SSI in neurosurgical patients were operational risk assessment score（OR=2.04）,frequency of preoperative antimicrobial use（OR=3.15）,frequency of intraoperative antimicrobial use（OR=2.58）,duration of operation（OR=2.70）,surgical blood loss（OR=1.72）,indwelling drainage tube（OR=4.30）,duration of indwelling drainage tube after operation（OR=2.06）,and time for initial dressing change（OR=1.66）;Multivariate conditional logistic regression analysis showed that the independent risk factors for SSI were frequency of preoperative antimicrobial use（P=0.03,OR=4.86）,duration of operation（P=0.05,OR=2.89）,and time for initial dressing change after operation（P=0.01,OR=1.92）.Conclusion Risk factors for SSI in department of neurosurgery are multiple,duration of operation,duration of indwelling drainage tube after operation,and time for initial dressing change after operation are major risk factors.

关 键 词：神经外科 手术部位感染 危险因素 配比病例对照 医院感染 

分 类 号：R181.32[医药卫生—流行病学]