骨科患者肺部医院感染危险因素分析  

Risk factors for nosocomial pulmonary infection in orthopedic patients

作　　者：谢朝云[1] 闫飞[1] 熊永发[1] 柏华[2] 

机构地区：[1]贵州医科大学第三附属医院骨科 [2]贵州医科大学第三附属医院医学实验中心

出　　处：《中国矫形外科杂志》2017年第5期426-431,共6页Orthopedic Journal of China

基　　金：贵州省科技厅联合项目(编号:黔科合LH字[2014]7162号);贵州省黔南州社会发展科技项目(编号:黔南科合社字[2013]20号)

摘　　要：[目的]分析骨科患者肺部医院感染的危险因素并提出临床防控参考措施。[方法]回顾2011年6月~2015年5月4 244例患者的临床资料,收集并逐一记录年龄、性别、住院天数、吸烟、恶性肿瘤、慢性阻塞性肺病、创伤、糖尿病、卧床、预防使用抗菌药物、使用糖皮质激素、留置导尿、手术治疗、机械通气治疗、血浆白蛋白浓度、血糖、是否伴有肺部医院感染,对其肺部医院感染的危险因素进行分析。[结果]单因素分析显示性别、住院天数、吸烟、恶性肿瘤、慢性阻塞性肺病、创伤、糖尿病、卧床、留置导尿、手术治疗、机械通气治疗、血浆白蛋白浓度、糖皮质激素、血糖等均是骨科患者肺部医院感染的危险因素(P<0.05);多因素分析显示年龄、糖尿病、卧床、留置导尿、手术、机械通气和血浆白蛋白浓度等7个因素为骨科肺部感染的主要危险因素(P<0.05)。[结论]骨科患者合并肺部医院感染的危险因素较多,应以主要危险因素为主,制定有效防控措施,避免不必要的预防使用抗菌药物,治疗用药应根据本地区骨科肺部医院感染病原菌及其耐药性特点,合理选用抗菌药物,减少骨科肺部医院感染发生。[Objective] To analyze the risk factors for nosocomial pulmonary infection in the department of orthopedics and to propose clinical preventive and control measures. [Methods] The clinical data of 4 244 orthopedic patients hospitalized from June 2011 to May 2015 were reviewed, and the following items were collected and recorded： age, gender, duration of hospital stay, smoking, malignant tumor, chronic obstructive pulmonary disease, trauma, diabetes, bed rest, use of antibiotics,use of glucocorticoids, indwelling catheterization, surgery, mechanical ventilation, plasma albumin level, blood glucose level,and nosocomial pulmonary infection. The risk factors for nosocomial pulmonary infection were analyzed. [Results] According to the results of univariate analysis, gender, hospital stay, smoking, malignant tumor, chronic obstructive pulmonary disease,trauma, diabetes, bed rest, indwelling catheterization, surgery, mechanical ventilation, plasma albumin level, glucocorticoids,and blood glucose level were risk factors for nosocomial pulmonary infection in orthopedic patients（P〈0.05）. According to the results of multivariate analysis, age, diabetes, bed rest, indwelling catheterization, surgery, mechanical ventilation, and plasma albumin level were risk factors for nosocomial pulmonary infection in orthopedic patients（P〈0.05）. [Conclusions]The risk factors for nosocomial pulmonary infection are multiple in orthopedic patients, and effective prevention and control measures should be developed aiming at those major risk factors, avoiding unnecessary application of antibacterial agents. Therapeutic drugs should be selected based on the pathogenic bacteria and their drug resistance characteristics to reduce the incidence of nosocomial pulmonary infection in the department of orthopedics.

关 键 词：骨科 肺部 医院感染 危险因素 LOGISTIC回归分析 

分 类 号：R197.323[医药卫生—卫生事业管理]