重型胸部创伤术后医院感染的相关因素  

Related factors of nosocomial infection in severe thoracic trauma patients after operation

作　　者：李鹏[1] 狄华明 余捍东 赵晶 李树坡 

机构地区：[1]三峡大学附属仁和医院胸外科,宜昌443000

出　　处：《中华创伤杂志》2017年第12期1105-1108,共4页Chinese Journal of Trauma

摘　　要：目的探讨重型胸部创伤术后发生医院感染的相关因素，为降低术后医院感染率提供依据及防治措施。方法采用回顾性病例系列研究分析2014年1月-2016年1月收治的重型胸部创伤手术患者148例，其中男98例，女50例；平均年龄34．7岁。简明损伤定级（AIS）≥3分。统计术后医院感染率，分析术后医院感染的相关因素，主要包括年龄、性别、既往基础疾病、是否昏迷、是否输血、手术方式、手术时间、气管插管时间、术后气管切开、术后ICU住院时间。结果本组患者术后18例发生医院感染，感染率为12．2％，其中肺部感染11例，尿路感染4例，切口感染2例，胸腔感染l例。致病病原菌中革兰阳性菌4例，为金黄色葡萄球菌，占22％；革兰阴性菌12例，占67％，其中肺炎克雷伯菌4例，鲍曼不动杆菌3例，铜绿假单胞菌3例，大肠埃希菌2例；真菌2例。术后医院感染与患者年龄（≥60岁）、既往基础疾病、昏迷、手术方式、手术时间（≥3h）、气管插管时间（≥24h）、术后气管切开、术后ICU住院时间（≥3d）等因素相关（P〈0．05），而与性别和是否输血无关（P〉0．05）。结论重型胸部创伤术后发生医院感染最常见致病菌为革兰阴性菌，年龄越大、合并基础疾病、昏迷、剖胸手术、手术时间过长、气管切开、气管插管时间长、气管切开及ICU住院时间长均是医院感染的危险因素，应重视这些危险因素，以尽可能减少术后医院感染的发生，减少对患者的伤害。Objective To investigate the related factors of nosocomial infection after severe thoracic trauma so as to provide basis and interventions for lowering nosocomial infection rate. Methods A retrospective case series study was conducted in 148 cases of severe thoracic trauma surgically treated from January 2014 to January 2016. There were 98 males and 50 females with an average age of 34.7 years. The abbreviated injury scale （AIS） was ≥ 3 points. The incidence of nosocomial infection was statistically analyzed. The possible factors related to nosocomial infection were analyzed, including age, gender, previous basic diseases, coma, blood transplantation, surgical procedure, operation time, tracheal intubation time, postoperative tracheotomy, and postoperative ICU hospitalization. Results Nosocomial infection occurred in 18 cases, with infection rate of 12.2%. There were 11 cases of pulmonary infection, four urinary tract infection, two incision infection, and one thoracic cavity infection. There were four cases （22%） of Gram-positlve bacteria as pathogen, both of which were Staphylococcus aureus. A total of 12 cases （67%） were Gram-negative bacteria, among which four were infected with Klebsiella pneumonia, three with Aeinetobacter banmannii, three with Pseudomonas aeruginosa, and two with Escherichia coll. Two cases were infected by fungi. The incidence of infection was correlated with the patients＇ age （ ≥ 60 years）, previous basic disease, coma, operation methods, operation time （ ≥13 hours）, endotracheal intubation time （ ≥ 24 hours）, tracheotomy after surgery, and postoperative hospitalization duration in the ICU （P 〈 0.05 ）, rather than gender and blood transplantation. Conclusions The most common pathogen of nosocomial infection in severe thoracic trauma patients is Gram-negative bacteria. The older age, previous basic diseases, coma, thoracotomy, long operation time, long tracheal intubation time, tracheotomy and long ICU hospital stay are the risk factors for nosocomi

关 键 词：胸部损伤 外科手术 交叉感染 危险因素 

分 类 号：R655[医药卫生—外科学]