神经外科患者术后医院感染的临床特点与影响因素及对策分析  

Clinical characteristics,risk factors and countermeasures for postoperative nosocomial infections in neurosurgery department patients

作　　者：王益丽[1] 洪春霞[1] 章学媛 卓玉荣 江静玉 范慧青 吴友红 WANG Yi-li;HONG Chun-xia;ZHANG Xue-yuan;ZHUO Yu- FAN Hui-qing;WU You-hong(Zhejiang Lishui City Center Hospital, Lishui, Zhejiang rong, JIANG Jing-yu, 323000, Chin)

机构地区：[1]丽水市中心医院神经外科,浙江丽水323000

出　　处：《中华医院感染学杂志》2018年第9期1384-1387,共4页Chinese Journal of Nosocomiology

基　　金：浙江省医药卫生科技基金资助项目(jq003122)

摘　　要：目的探讨神经外科手术患者医院感染的影响因素,为制定医院感染的预防及控制措施提供客观依据。方法选取2012年12月-2016年12月医院神经外科收治并进行手术的2560例患者作为研究对象,回顾性分析患者性别、年龄、原发及基础疾病、住院时间、血糖、手术信息、是否实施围术期护理干预等临床信息。统计入组患者医院感染概况、并对相关影响因素进行单因素及多因素Logistic分析。结果 2560例患者中,460例发生医院感染,医院感染率为17.97%;总感染例次为506例次,总例次感染率为19.77%;同期住院患者床日数为64152d,总发病密度为7.17‰。手术部位感染构成比最高(195例次,占38.54%)。随着NNIS评分级别升高,手术部位感染率呈逐渐增高趋势(χ2=21.409,P=0.003);单因素分析结果显示:年龄、原发病、基础疾病、住院时间、术后再次手术、高血糖、使用糖皮质激素、使用胃酸抑制剂、实施围术期护理干预均为神经外科患者术后发生医院感染的影响因素;多元Logistic回归分析结果显示:年龄≥60岁、住院时间>22d、术后再次手术、高血糖、神经系统肿瘤、脑血管疾病、基础疾病、使用糖皮质激素、使用胃酸抑制剂、围术期护理干预均为神经外科术后患者发生医院感染的独立影响因素。结论神经外科手术患者医院感染率较高,手术部位感染、下呼吸道感染是主要感染类型,感染的发生情况是年龄、原发疾病、基础疾病、住院时间、血糖、是否实施围术期护理干预等多因素共同作用结果。OBJECTIVE To explore the risk factors for nosocomial infections in patients of neurosurgery department so as to provide objective basis for prevention and control of the nosocomial infections.METHODS A total of 2560 patients who received surgical procedures in the neurosurgery department from Dec 2012 to Dec 2016 were recruited as the study objects.The clinical data of the patients,including the genders,age,primary and underlying diseases,length of hospital stay,blood glucose,surgery information and perioperative nursing interventions,were retrospectively analyzed.The incidence of nosocomial infections was statistically analyzed,and the univariate analysis and multivariate logistic regression analysis were performed for the influencing factors.RESULTS Of the 2560 patients,460 had nosocomial infection,with the infections rate 17.97%.Totally 506 case-times of patients had infections,with the total case-time infection rate 19.77%.The number of bed days of the hospitalized patients was64152 days,the total morbidity density was 7.17‰.The patients with surgical site infections were dominant,accounting for 38.54%（195 cases）.The incidence of surgical site infection showed an upward trend with the increase of NNIS（χ2=21.409,P=0.003）.The result of univariate analysis showed that the independent influencing factors for the postoperative nosocomial infections in the neurosurgery department patients included the age,primary disease,underlying disease,length of hospital stay,reoperation,hyperglycemia,use of glucocorticoids,use of gastric acid inhibitors and perioperative nursing interventions.The result of multivariate logistic regression analysis indicated that the risk factors for the postoperative nosocomial infections in the patients of neurosurgery department included the no less than 60 years of age,length of hospital stay more than 〉22 days,reoperation,nervous system tumors,cerebrovascular disease,underlying disease,use of glucocorticoids,use of gastric acid inhibitors and perioperative nursing intervention

关 键 词：神经外科 医院感染 相关影响因素 

分 类 号：R619[医药卫生—外科学]