输尿管镜钬激光碎石术后患者医院感染的影响因素分析及护理干预对策  

Analysis of factors influencing nosocomial infection after holmium laser lithotripsy under ureteroscopy and nursing intervention measures

作　　者：许思怡[1] 邓琴[1] 蒙小琴[1] 蔡文妍 商颖[1] XU Si-yi;DENG Qin;MENG Xiao-qin;CAI Wen-yan;SHANG Ying(The First Affiliated Hospital of Hainan Medical University,Haikou,Hainan 570102,China)

机构地区：[1]海南医学院第一附属医院泌尿外科,海南海口570102

出　　处：《中华医院感染学杂志》2018年第22期3462-3465,共4页Chinese Journal of Nosocomiology

基　　金：2012年海南省自然科学基金资助项目(812190)

摘　　要：目的探究泌尿系结石患者行输尿管镜钬激光碎石术后发生医院感染的影响因素,提出有效的护理干预预防对策。方法选取医院2014年1月-2016年12月收治的424例泌尿系结石患者作为研究对象,分析患者术后发生医院感染情况,收集感染患者标本进行病原学检测;单因素分析患者的性别、病史、导尿管置入、手术时间等临床资料,有统计学意义的行多因素logistic回归分析以探讨发生感染的影响因素,并根据影响因素提出针对性的护理预防对策。结果 424例泌尿系结石患者中共有14例患者发生泌尿系统感染,感染率为3.30%,感染主要以急性肾盂肾炎感染为主,共8例;14例泌尿系统感染患者共分离培养出病原菌17株,其中革兰阴性菌11株、革兰阳性菌6株,病原菌以大肠埃希菌为主;多因素logistic回归分析结果显示:肾积水、导尿管置入、结石体积较大是肾结石患者行输尿管镜钬激光碎石术后发生医院感染的影响因素(P<0.05)。结论泌尿系结石患者行输尿管镜钬激光碎石术后容易受到多种病原菌感染,应早期经验性使用抗菌药物,并根据感染的影响因素针对性的采取预防措施,减少感染率。OBJECTIVE To explore the influencing factors of nosocomial infection after ureteroscopy holmium laser lithotripsy in patients with urinary calculi,and put forward effective nursing intervention prevention measures.METHODS 424 cases of urinary calculi patients treated from Jan.2014 to Dec.2016 were enrolled as research objects,the incidence of postoperative nosocomial infection for the patients was analyzed,and the specimens were collected for etiology detection.Univariate analysis was conducted on the clinical data of the patients such as gender,medical history,catheterization and surgery duration.Multivariate logistic linear regression analysis was used to investigate the risk factors for infection,and pertinent nursing preventive countermeasures were put forward accordingly.RESULTS There were 14 cases of postoperative urinary infection in 424 patients with urinary stones,and the infection rate was 3.30%,among which 8 cases were acute pyelonephritis,accounting for 57.14%.A total of17 strains of pathogenic bacteria were isolated and cultured in the 14 cases of patients,among which 11 strains of gram-negative bacteria accounted for 64.71% and 6 strains of gram-positive bacteria accounted for 35.29%.The pathogens were dominated by Escherichia coli.Multivariate logistic regression analysis results showed that the hydronephrosis,catheterization and relatively large stone as risk factors for nosocomial infection after ureteroscopy holmium laser lithotripsy in patients with urinary calculi,the difference was significantly significant（P〈0.05）.CONCLUSIONPatients with urinary calculi who undergo ureteroscopy holmium laser lithotripsy are susceptible to infections caused by various pathogenic bacteria after operation.It is of great significance to use the corresponding antibacterial drugs at an early stage according to the analysis results of pathogenic bacteria.However,it is more important to take preventive measures according to the risk factors of infection to reduce the incidence of infection.

关 键 词：钬激光 感染 影响因素 预防 

分 类 号：R619.3[医药卫生—外科学]