重型颅脑损伤术后感染相关因素及针对性护理的效果观察  

Analysis of postoperative infection-related factors for patients with severe traumatic brain injury after operation and their targeted nursing

作　　者：徐晓[1] 高利华 梁陶媛[2] XU Xiao;GAO Li-hua;LIANG Tao-yuan(Department of Critical Care Medicine,Beijing Jishuitan Hospital,Beijing 100035,China;Department of Comprehensive Surgical,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院重症医学科,北京100035 [2]北京积水潭医院综合外科,北京100035

出　　处：《中国临床神经外科杂志》2020年第11期791-793,共3页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨重型颅脑损伤术后感染相关因素及针对性护理的效果。方法回顾性分析2017年7月至2019年7月手术治疗的165例重型颅脑损伤的临床资料。根据术后护理方法分为常规护理组(n=91)和针对性护理组(n=74)。结果165例中,术后29例发生感染,感染率为17.58%。2017年7月至2018年8月采用常规护理91例,其中21例发生感染,包括颅内感染10例,切口感染6例,呼吸道感染3例,导管相关血流感染2例。2018年9月改进护理方案为针对性护理74例,其中8例发生感染,包括颅内感染3例,切口感染2例,呼吸道感染2例,导管相关血流感染1例。针对性护理组感染率(12.16%)明显低于常规护理组感染率(23.08%;P<0.05)。多因素logistic回归分析显示,术前GCS评分<5分、手术时间≥4 h、术后ICU住院时间≥2周、术后白蛋白水平<35 g/L、气管切开术、深静脉置管以及术后无针对性护理为术后感染的独立危险因素(P<0.05)。结论重型颅脑损伤术后感染相关因素众多,针对性护理能够有效降低感染的风险。Objective To explore the postoperative infection-related factors for patients with severe traumatic brain injury(TBI after operation and the preventive effectiveness of targeted nursing. Methods The clinical data of 165 patients with severe TBI underwent surgery from July 2017 to July 2019 were retrospectively analyzed. Of thses 165 patients, 91 patients received routine nursing(routine nursing group) and 74 received targeted nursing(targeted nursing group). The postoperative infection-related factors were analyzed by multivariate lgostic regession analysis. Results Of these 165 patients, 29 patients had infection after the surgery, with an infection rate of 17.58%. The infection rate of the targeted nursing group(12.16%) was significantly lower than that of the routine nursing group(23.08%;P<0.05). The results of multivariate lgostic regession analysis showed preoperative GCS score <5 points, operation time ≥4 hours, postoperative ICU stay ≥2 weeks, postoperative albumin level <35 g/L, the proportion of patients with tracheotomy, deep vein catheter and postoperative routine nursing are independent risk factors for postoperative infection in patients with severe TBI(P<0.05).Conclusions There are many risk factors for the postoperative infection in the patients with severe TBI after the operation. Targeted nursing can effectively reduce the risk of infection.

关 键 词：重型颅脑损伤 显微手术 术后感染 危险因素 针对性护理 

分 类 号：R651.15[医药卫生—外科学] R473.6[医药卫生—临床医学]