肠梗阻患者术后医院感染病原菌与影响因素分析  

Etiological characteristics and risk factors of nosocomial infection in patients with intestinal obstruction

作　　者：蒋正顺 尤祥正 郑米华 王瑜 林成平 JIANG Zheng-shun;YOU Xiang-zheng;ZHENG Mi-hua;WANG Yu;LIN Cheng-ping(Second People's Hospital of Linhai,Linhai, Zhejiang 317016, China)

机构地区：[1]浙江省临海市第二人民医院普外科,浙江临海317016

出　　处：《中华医院感染学杂志》2019年第8期1190-1193,共4页Chinese Journal of Nosocomiology

基　　金：国家科技支撑计划基金资助项目(2015BAI25A09)

摘　　要：目的探讨肠梗阻患者术后医院感染病原菌特点与感染的影响因素。方法选择2013年4月-2017年3月于医院行肠梗阻手术治疗的患者278例为研究对象,采集肠梗阻患者术后切口感染的相关标本,进行病原菌分析。分析患者年龄、性别、体重指数、美国麻醉医师协会(ASA)分级和急性生理与慢性健康(APACHE II)评分等临床资料,归纳肠梗阻患者术后医院感染的影响因素。结果 278例患者中发生感染83例,感染率为29.86%,以切口部位感染为主,占71.08%;结果显示,在各年份医院感染率呈现明显下降的趋势,其中2013.04～2014.04期间医院感染率达40.96%,而在2016.05～2017.03期间医院感染率只有14.46%(P<0.05);83例发生感染患者标本共培养分离病原菌108株,其中革兰阴性菌58株占53.70%,革兰阳性菌47株占43.52%,真菌3株占2.78%;多因素Logistic回归分析结果显示,年龄、ASA分级、APACHE-II评分、合并糖尿病、手术时间、住院时间及合并闭袢性肠梗阻是肠梗阻患者术后医院感染的影响因素(P<0.05)。结论肠梗阻患者术后医院感染的影响因素较多,临床需采取针对性的干预措施,以降低肠梗阻患者术后医院感染率。OBJECTIVE To investigate the characteristics of pathogens and postoperative nosocomial infection of patients with intestinal obstruction. METHODS A total of 278 patients who underwent surgery for intestinal obstruction from Apr. 2013 to Mar. 2017 were enrolled in this study. The relevant specimens of postoperative incision infection in patients with intestinal obstruction were collected for pathogen analysis. Clinical data such as age, gender, body mass index, American Society of Anesthesiologists (ASA) classification, and acute physiology and chronic health (APACHE II) scores were analyzed to summarize the factors associated with postoperative nosocomial infection in patients with intestinal obstruction. RESULTS Of the 278 patients, 83 (29.86 %) were infected, mainly at the incision site, accounting for 71.08%. The nosocomial infection rate showed a significant downward trend in each year. The nosocomial infection rate was 40.96 % in Apr. 2013 - Apr. 2014, but only 14.46% in May 2016 - Mar. 2017. 108 strains of pathogens were isolated from the 83 infected patients. 58 strains of gram -negative bacteria accounted for 53.70%, 47 strains of gram- positive bacteria accounted for 43.52%, and 3 strains of fungi accounted for 2.78%. The results of multivariate Logistic regression analysis showed that age, ASA grade, APACHE-II score, diabetes mellitus, operation time, hospital stay and closed loop intestinal obstruction were the influencing factors of postoperative nosocomial infection in patients with intestinal obstruction (P <0.05). CONCLUSION There are many influencing factors of postoperative nosocomial infection in patients with intestinal obstruction. It is necessary to take specific intervention measures in order to reduce the nosocomial infection rate in patients with intestinal obstruction after operation.

关 键 词：肠梗阻 医院感染 病原菌 影响因素 

分 类 号：R619.3[医药卫生—外科学]