消化内镜术后患者院内感染原因及其防范对策分析  

Analysis of the causes of nosocomial infection in patients after digestive endoscopy and its preventive measures

作　　者：黄晓丽[1] 张丽丽[1] 冯凯祥[1] 彭兰[2] HUANG Xiao-li;ZHANG Li-li;FENG Kai-xiang;PENG Li(Department of Gastroenterology,Mianyang Central Hospital,Sichuan,Mianyang 621000,China;Department of Gastroenterology,Affiliated Hospital & Clinical Medical College of Chengdu University,Chengdu 610081,China)

机构地区：[1]绵阳市中心医院消化内科,四川绵阳621000 [2]成都大学附属医院消化内科,成都610081

出　　处：《中国医学前沿杂志（电子版）》2019年第10期122-126,共5页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

基　　金：四川省卫生和计划生育委员会科研课题（16PJ001）

摘　　要：目的探讨消化内镜术后患者院内感染的发生原因,制订相应防范对策,并观察对策实施结果。方法选取绵阳市中心医院2016年3月至2017年2月入住并接受消化内镜手术治疗的328例患者为研究对象,将其中发生院内感染的19例患者纳入观察组,未发生院内感染的309例患者纳入对照组,收集患者机体情况、治疗情况、手术和住院情况进行单因素分析和多因素非条件Logistic回归分析,绘制受试者操作特征曲线分析,明确消化内镜术后患者发生院内感染的危险因素及其相关因素的最佳截断值,制订相应防范对策并与次年同期346例接受消化内镜手术后采取院内感染防范措施的患者院内感染发生率进行对比。结果消化内镜术后患者发生院内感染与其年龄、住院天数、卧床时间、手术时间、合并低蛋白血症、术前应用免疫抑制剂、引流管留置、经中央静脉插管有关(均P<0.05)。年龄≥60岁、合并糖尿病、术前应用免疫抑制剂、引流管留置时间长、经中央静脉插管、合并低蛋白血症、住院天数长、手术时间长、卧床时间长均为首年消化内镜术后发生院内感染的危险因素(均P<0.05)。采取相应的防范措施后院内感染发生率自5.79%降至1.16%。结论消化内镜患者术后发生院内感染的危险因素包括患者年龄≥60岁、住院天数超过14d、卧床时间超过20d、手术时间超过70min、合并低蛋白血症、术前应用免疫抑制剂、引流管留置时间超过14d及经中央静脉插管,完善相关防范措施有利于降低消化内镜术后院内感染发生率。Objective To explore the causes of nosocomial infection in patients after digestive endoscopy, to develop corresponding preventive measures, and to observe the results of the countermeasures. Method 328 patients admitted to Mianyang Central Hospital from March 2016 to February 2017 and underwent digestive endoscopy were selected as the subjects. Among them, 19 patients with nosocomial infection were included in observation group, and 309 patients without nosocomial infection were included in control group. The body condition, treatment, operation and hospitalization of the patients were analyzed by univariate analysis, multivariate unconditional Logistic regression analysis and receiver operating curve analysis, and the best cut-off values of risk factors and related factors for digestive endoscopy surgery were determined. The corresponding preventive measures were worked out and compared with the incidence of nosocomial infection in 346 patients who took preventive measures against nosocomial infection after digestive endoscopy in the same period of the following year. Result Nosocomial infection after digestive endoscopy were related to the age, hospitalization, bed time, operation time, hypoalbuminemia, preoperative application of immunosuppressant, placement of drainage tube and central venous catheterization (all P < 0.05). The risk factors included age ≥ 60 years old, diabetes mellitus, pre-operation of immunosuppressants, combined hypoproteinemia, hospitalization time more than 14 d, time of indwelling drainage tube for more than 14 d, operation time of more than 70 min, bed time more than 20 d, and central venous cannulation. The incidence of hospital infection decreased from 5.79% to 1.16%. Conclusion The risk factors of nosocomial infection after digestive endoscopy are age ≥ 60 years old, hospitalization time more than 14 d, bed rest time more than 20 d, operation time more than 70 minutes, accompanied by hypoalbuminemia. Immunosuppressive agents, drainage tube placement time 14 d before operation

关 键 词：消化道 消化内镜 院内感染 防范对策 

分 类 号：R57[医药卫生—消化系统]