中晚期恶性肿瘤手术患者发生手术室医源性感染的危险因素调查  

Risk factors of iatrogenic infection in patients with middle-late malignant tumor during operation

作　　者：沈爱莲[1] 邬术平 张晓菁[1] 蒋希英 

机构地区：[1]攀钢集团总医院密地院区麻醉科,四川攀枝花617063

出　　处：《海南医学》2017年第6期997-1000,共4页Hainan Medical Journal

基　　金：四川省科技厅科技支撑计划项目(编号:2013FZ2239)

摘　　要：目的调查中晚期恶性肿瘤手术患者发生手术室医源性感染的危险因素,为肿瘤患者手术室医源性感染的预防提供参考。方法收集2012年1月至2016年10月期间在我院手术室行手术治疗的1 523例中晚期恶性肿瘤患者的临床资料,对临床资料进行整理,分析手术室医源性感染发生情况及引起感染发生的危险因素。结果 1 523例患者中326例发生术后感染,感染率为21.41%,其中86例经追踪寻找感染来源确定为手术室医源性感染,感染率为5.65%,占术后医院感染的26.38%;感染途径57例为体液感染、12例为尿液感染、8例为粪便感染、4例为血液感染、2例为手术器械感染、3例为其他因素感染,分别为66.28%、17.65%、9.30%、4.65%、2.33%、3.49%;患者不同性别、原发疾病、术前是否合并营养不良、术前是否合并糖尿病、术前是否使用糖皮质激素均与手术室医源性感染发生无相关性(P>0.05),连台手术、手术室内人员≥10人、术中反复多次侵入性操作时感染率分别为8.96%、10.73%、8.37%,非连台手术、手术室内人员<10人、无术中反复多次侵入性操作时感染率分别为4.17%、4.62%、4.40%,差异均有统计学意义(P<0.05);多因素Logistic回归分析显示,患者为连台手术、手术室内人员≥10人、术中反复多次侵入性操作是影响手术室医源性感染的独立危险因素(P<0.05)。结论手术为连台手术、手术室内人员较多及术中反复多次侵入性操作是引起中晚期恶性肿瘤手术患者发生手术室医源性感染的危险因素,应针对以上因素进行干预以降低手术室医源性感染的发生。Objective To discuss the risk factors of iatrogenic infection in the operating room in patients with middle-late malignant tumor during operation, and provide the reference for the prevention of nosocomial infection in operation room of cancer patients. Methods The clinical data of 1 523 patients with advanced malignancy who underwent surgery in our hospital from January 2012 to October 2016 were collected and sorted out. The incidence of iatrogenic infection and the infection risk factors were analyzed. Results Among these 1 523 cases, 326 cases had the postoperative infection with the infection rate of 21.41%. A total of 86 cases were found to be iatrogenic infection with the infection rate of 5.65%, accounting for 26.38% of postoperative nosocomial infection. In the infection route, there were 57 cases of body fluid infection, 12 cases of urine infection, 8 cases of fecal infection, 4 cases of blood infection, 2 cases of surgical instrument infection, and 3 cases of other factors, accounting for 66.28%, 17.65%, 9.30%, 4.65%, 2.33%,3.49%, respectively. The different gender, primary diseases, whether preoperative malnutrition, whether preoperative diabetes mellitus, whether the preoperative use of glucocorticoid, had nothing to do with iatrogenic infection in the operating room（P〉0.05）. The infection rates of continuous operation, operating room personnel ≥ 10 people and intraoperative repeatedly invasive operation were 8.96%, 10.73%, 8.37%, respectively; the infection rates of non-continuous operation, operating room personnel 〈10 people, or non-intraoperative repeatedly invasive operation were 4.17%, 4.62%,4.40%, respectively, and all of the differences of above factors were statistically significant（P〈0.05）. Multivariable logistic regression analysis showed that continuous operation, operating room personnel ≥ 10 people and intraoperative repeatedly invasive operation were the independent risk factors of iatrogenic infection in the operating room（P〈0.05）.Conclusion The continuous opera

关 键 词：恶性肿瘤 手术 手术室 医源性感染 危险因素 

分 类 号：R730.56[医药卫生—肿瘤]