神经外科手术患者院内感染危险因素分析  

Risk factors of nosocomial infection in patients in department of neurosurgery

作　　者：丘琪政[1] 刘文浩[1] 张文波[1] 张光宇[1] 黄进兴[1] 罗兴达 

机构地区：[1]梅州市人民医院神经外一科,广东省梅州514000

出　　处：《中国医师杂志》2017年第3期399-402,共4页Journal of Chinese Physician

摘　　要：目的分析神经外科手术患者发生院内感染的危险因素，为临床防治感染提供依据。方法纳入2012年1月至2016年1月本院住院治疗的931例行神经外科手术患者，患者收治入院后即刻收集患者的病史资料，包括年龄、性别、基础疾病、原发疾病等；记录患者的手术情况，包括术前白细胞数量、术前血糖水平、手术持续时间、有无术后再次手术等；记录患者的住院情况，包括住院时间、有无使用糖皮质激素、有无使用质子泵抑制剂、有无气管插管/切开等。根据患者住院期间是否发生院内感染将患者分为感染组及非感染组，对两组临床资料差异有统计学意义的变量进行Logistic多因素回归分析。结果共112例患者发生院内感染，感染率为12.03%，感染发生在术后3～25（7.5±1.8）d。患者的主要感染部位为术后伤口，占35.7%；其次为呼吸道，占34.8%。共检出病原菌64株，其中革兰阴性菌41株，占64.1%，革兰阳性菌21株，占32.8%，真菌2株，占3.1%。感染组患者≥60岁、有基础疾病、再次手术、合并其他损伤、白细胞数量异常、术前高血糖、使用糖皮质激素、使用质子泵抑制剂、气管切开、留置引流管所占比例均明显高于非感染组患者，住院时间及手术时间也高于非感染组患者，差异均有统计学意义（P〈0.05）。进一步行Logisitc回归分析，结果显示年龄、再次手术、住院时间、术前高血糖、气管切开是神经外科手术患者院内感染的危险因素。结论对于年龄较大、行再次手术、住院时间较长、存在术前高血糖及气管切开的患者可以采取针对性措施提高患者的免疫力，通过合理使用抗菌药物避免患者术后感染的发生。Objective To analyze the risk factors of nosocomial infection in Department of Neurosurgery and to provide evidence for the prevention and treatment of infection. Methods A total of 931 patients with neurosurgery operation in our hospital from January 2012-January 2016 were collected medical history data immediately after admission, including age, gender, underlying diseases, and primary diseases. Surgical records include preoperative white blood cell count, blood glucose level before operation, duration of operation, and reoperation. Hospitalization records include hospitalization time, without the use of corticosteroids, with or without the use of proton there is no pump inhibitor, and tracheal intubation/incision. Patients were divided into infection group and non infection group according to whether the hospital infection occurred during hospitalization. The difference of two groups of clinical data with statistically signifi- cant variables was Logistic multivariate regression analysis. Results There were 112 patients with nosocomial infection, the infection rate was 12. 03% , and the infection occurred in the postoperative 3 -25 d. The main infection site was postoperative wound, accounting for 35.7%; respiratory tract, accounting for 34. 8%. There were 64 strains of pathogenic bacteria, 81 strains of Gram-negative bacteria, accounting for 64. 1% , 21 strains of gram positive bacteria, accounting for 32. 8% , 2 strains of fungi, accounting for 3.1%. There were significant difference between infection group and non infection group in ≥ 60 years, with basic diseases, reoperation, combined with other injuries, white blood cells, abnormal preoperative hyperglycemia, glucoeorticoid use, proton pump inhibitors use, tracheotomy, hospitalization time, operation time （P 〈 0. 05）. Further Logisite regression analysis showed that age, reoperation, hospitalization time, preoperative high blood sugar and tracheotomy were the risk factors of nosocomial infection in Department of neurosurgery. Conclusions For the

关 键 词：神经外科手术 交叉感染 危险因素 

分 类 号：R651[医药卫生—外科学]