下咽癌切除术后患者医院感染的相关因素分析及预防对策研究  

Related factors for postoperative nosocomial infections in patients undergoing hypopharyngeal carcinoma resection and prevention countermeasures

作　　者：吕渊[1] 裘世杰[1] 邬振华[1] 叶栋[1] 沈志森[1] LYU Yuan;QIU Shi-jie;WU Zhen-hua;YE Dong;SHEN Zhi-sen(Li Huili Hospital of Ningbo Medical Center,Ningbo,Zhejiang 315000,China)

机构地区：[1]宁波市医疗中心李惠利医院耳鼻咽喉头颈外科,浙江宁波315000

出　　处：《中华医院感染学杂志》2018年第13期2016-2019,共4页Chinese Journal of Nosocomiology

基　　金：浙江省自然科学基金资助项目(LQ16H160018)

摘　　要：目的探讨下咽癌患者行下咽癌切除术治疗后医院感染发生的影响因素,为预防术后医院感染发生及加速患者康复提供参考依据。方法选取医院2012年1月-2016年12月120例下咽癌患者临床资料,所有患者均行下咽癌切除术治疗,分析下咽癌切除术后医院感染发生的影响因素,进行多因素Logistic回归分析,并据此提出相应预防对策。结果下咽癌切除术后医院感染发生率为13.33%(16/120),共检出病原菌14株,其中铜绿假单胞菌6株,占42.86%;金黄色葡萄球菌3株,占21.43%;经单因素分析,术前放疗、临床III分期以上、手术时间、基础疾病、侵入性操作、抗菌药物使用、营养不良为下咽癌切除术后医院感染影响因素;多因素分析,术前放疗、基础疾病、侵入性操作、抗菌药物使用、营养不良、临床III期以上、手术时间>4h为下咽癌切除术后医院感染的独立影响因素。结论下咽癌切除术后医院感染影响因素较多,可根据药敏试验结果来合理选择抗菌药物,根据患者术后医院感染影响因素来实施相应预防对策。OBJECTIVE To explore the influencing factors for postoperative nosocomial infections in hypopharyngeal cancer patients undergoing hypopharyngeal carcinoma resection so as to provide guidance for prevention of the postoperative nosocomial infection and accelerate recovery of the patients.METHODS The clinical data were collected from the patients with hypopharyngeal cancer who were treated in the hospital from Jan 2012 to Dec 2016,all of the patients received the hypopharyngeal carcinoma resection,the influencing factors for the postoperative nosocomial infection were analyzed,the multivariate logistic regression analysis was performed,and the corresponding prevention countermeasures were put forward.RESULTS The incidence rate of postoperative nosocomial infections was 13.33%（16/120）.A total of 14 strains of pathogens were isolated,6（42.86%）of which were Pseudomonas aeruginosa,and 3（21.43%）were Staphylococcus aureus.The univariate analysis showed that the influencing factors for the postoperative nosocomial infections included preoperative radiotherapy,clinical stage III or above,operation duration,underlying diseases,invasive operation,use of antibiotics and malnutrition.The multivariate analysis indicated that the preoperative radiotherapy,underlying diseases,invasive operation,use of antibiotics,malnutrition,clinical stage III or above and operation duration more than 4 hours were the independent influencing factors for the postoperative nosocomial infection in the patients undergoing the hypopharyngeal carcinoma resection.CONCLUSION There are a variety of influencing factors for the postoperative nosocomial infection in the patients undergoing the hypopharyngeal carcinoma resection.It is necessary to reasonably use antibiotics based on the result of the drug susceptibility testing and take the targeted prevention countermeasures according to the influencing factors.

关 键 词：下咽癌切除术 医院感染 预防对策 因素 

分 类 号：R739.63[医药卫生—肿瘤]