320例肝癌介入化疗患者医院感染的病原菌分布及影响因素分析  

Analysis of distribution and influencing factors of nosocomial infections in 320 patients in our hospital with interventional chemotherapy for liver cancer

作　　者：李洵仪 吴耀华[2] LI Xunyi;WU Yaohua(Surgery of First Affiliated Hospital of Harbin Medical University,150001;Thyroid surgery of First Affiliated Hospital of Harbin Medical University,150001)

机构地区：[1]哈尔滨医科大学附属第一医院外科,150001 [2]哈尔滨医科大学附属第一医院甲状腺外科,150001

出　　处：《现代消化及介入诊疗》2020年第4期444-448,共5页Modern Interventional Diagnosis and Treatment in Gastroenterology

基　　金：国家自然科学基金(81502605)。

摘　　要：目的探讨肝癌介入化疗患者医院感染的病原菌分布及影响因素。方法现将2017年4月至2018年10月就诊于我院的320例肝癌介入化疗患者作为研究对象,对患者的就诊情况进行回顾性分析,观察和分析患者发生医院感染的病原菌分布情况以及影响医院感染的独立影响因素。结果本次参与调查的320例患者中,出现医院内感染的有125例,其发生率为39.1%。在医院感染的125例患者的中共分离出91株病原菌,其中革兰氏阴性菌48例,革兰氏阳性菌43例,革兰氏阴性菌所占比例较高。此外,感染部位主要以肠道(18.4%)、肺部(24.8%)以及腹膜感染(15.2%)为主。应用多因素Logistic回归对影响医院感染的独立影响因素进行分析,影响医院感染的独立影响因素包括年龄(OR=1.175,P<0.001)、手术时间(OR=2.121,P<0.001)、术前ALB水平(OR=1.885,P<0.001)、侵入性操作(OR=1.582,P<0.001)、术中出血量(OR=1.463,P<0.001)、抗菌药物应用时间(OR=1.437,P<0.001)以及住院时间(OR=1.457,P<0.001)。结论肝癌介入化疗患者医院感染的病原菌分布主要以革兰阴性菌为主,其影响因素相对较多,包括手术时间、住院时间、侵入性操作、术前ALB水平、术中出血量、抗菌药物应用时间以及年龄等,针对以上因素临床医生需要给予足够的重视,并采取一定的预防措施,以降低患者的感染率。Objective To discuss the distribution and influencing factors of nosocomial infection in patients with hepatocellular carcinoma undergoing interventional chemotherapy. Methods 320 patients with hepatocellular carcinoma treated with interventional chemotherapy from April 2017 to October 2018 were selected as the research objects. The patients’ visits were analyzed retrospectively.The distribution of pathogens causing nosocomial infection and the independent influencing factors were observed and analyzed. Results Among 320 patients who participated in the survey,125 cases had nosocomial infection,the incidence rate was 39. 06%. Among the 125 patients with nosocomial infection,a total of 91 strains of pathogenic bacteria were isolated,among which there were 48 cases of gram-negative bacteria and 43 cases of gram-positive bacteria,with a high proportion of gram-negative bacteria. The main infection sites were intestinal tract( 18. 4%),lung( 24. 8%) and peritoneal infection( 15. 2%). Multivariate logistic regression was used to analyze the independent influencing factors of nosocomial infection. It was found that the independent influencing factors of nosocomial infection included the following: age( OR = 1. 175,P < 0. 001),operation time( OR = 2. 121,P < 0. 001),preoperative ALB level( OR =1. 885,P < 0. 001),invasive operation( OR = 1. 582,P < 0. 001),intraoperative blood loss( OR = 1. 463,P < 0. 001),application time of antibiotics( OR = 1. 437,P < 0. 001) and length of stay( OR = 1. 457,P < 0. 001). Conclusion Gram-negative bacteria are the main pathogens of nosocomial infection in patients with hepatocellular carcinoma undergoing interventional chemotherapy. The influencing factors are relatively large,including operation time,hospitalization time,invasive operation,preoperative ALB level,intraoperative bleeding volume,application time of antibiotics and age. Clinicians should pay enough attention to these factors and take certain preventive measures to reduce the infection of patients.

关 键 词：肝癌介入化疗 医院感染 病原菌分布 影响因素 

分 类 号：R322.47[医药卫生—人体解剖和组织胚胎学] R575[医药卫生—基础医学]