危重患者医院感染临床调查分析  

Infection Analysis on Intensive Care Units Patients

作　　者：张亚莉[1] 杨云滨[1] 汪能平[1] 陈进华[1] 

机构地区：[1]第一军医大学附属南方医院,广东广州510515

出　　处：《中华医院感染学杂志》2003年第2期120-123,共4页Chinese Journal of Nosocomiology

摘　　要：目的　了解我院重症监护病房 (ICU)患者的医院感染情况 ,对重症监护患者医院感染的有关因素进行探讨。方法　以主动监测方法对 2 0 0 1年全院所有ICU患者依据患者临床症状、体格检查、血像、细菌培养、X线检查等确定诊断。结果　ICU患者的医院感染率为 18.0 % ,显著高于同期医院平均感染率 (5 .5 % ) ;随着年龄的增长感染率上升 ,基础病感染率以肿瘤、外科开放性损伤 (尤其是颅脑外伤 ) ,医院感染发生率最高 ;医院感染的部位分布 ,以下呼吸道感染最多 ,占 4 8.5 %。有高危因素的医院感染率高达 4 1.3% ,显著高于没有高危因素的感染发生率 (6 .7% ) ,且高危因素越多 ,感染率越高 ,ICU医院感染病原菌以铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌等革兰阴性菌为主 ,在革兰阳性菌中 ,以金黄色葡萄球菌、表皮葡萄球菌、粪肠球菌为主。结论　ICU是医院感染的高发单位 ,应作为重点监测 ,尤其是高龄、肿瘤、脑外伤等高危疾病和进行侵入性诊疗的患者。OBJECTIVE To survey the infection status in intensive care units (ICU) patients of our hospital, and to analyze the risk factors. METHODS In order to inspect all the infection cases in our hospital ICU during 2001, the infection diagnosis was made according to physical examination, clinical manifestation, peripheral blood WBC count, and bacterial culture.RESULTS The infection rate in ICU patients in 2001 was 18.0%, statistically higher than that in common patients which was 5.5%. The infection rate became higher in elderly patients. The highest infection rates happened in tumor, open injury, especially the head injury patients. The lower respiratory tract is the most vulnerable site to infection, accounting for 48.5% of all hospital infection. The infection rate (41.3%) in patients with high risk factors is much higher than that in patients without high infection risk factors (6.7%), and the infection rate goes up with the number of risk factors that the patients are exposure to. Based on the analysis on the 360 infection cases, urinary tract intubation is the highest iatrogenic risk factor, then the application of cortisone, general anesthesia, tracheotomy, blood vessel intubation, and coma in order. Long duration of surgical operation time can also put the patients at risk. The most common infection bacteria in ICU are Pseudomons aeruginosa, Klebsiella pneumoniae, Escherichia coli, Staphylococcus aureus, S. epidermidis, Enterococcus faecalis. CONCLUSIONS ICU are the places where hospital infection rate is much higher than at other places, and should be supervised intensively. Special attention should be paid to elderly, tumor, and head injury patients in ICU for infection.

关 键 词：危重患者 医院感染 临床 调查分析 危险因素 重症监护病房 

分 类 号：R181.34[医药卫生—流行病学]