全身麻醉手术患者医院感染的危险性因素及预防措施
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摘要
目的研究全身麻醉手术患者医院感染的危险性因素及预防措施。方法回顾性分析2015年12月至2018年1月在重庆市涪陵中心医院行全身麻醉手术的618例患者的临床资料,观察患者术后医院感染状况以及筛查、分析与归纳医院感染的危险因素。结合专业知识,建立多因素Logistic逐步回归模型,对有意义变量进行分析。结果 618例全身麻醉手术患者中医院感染49例,感染率为7.93%,其中569例全身麻醉手术医院未感染者与49例感染者临床及手术资料特征比较差异均无统计学意义(P>0.05);医院感染者和未感染者的ASA分级>II级构成比(77.55%vs 30.2%)、全凭静脉麻醉构成比(69.39%vs 35.85%)、麻醉通气时间≥2 h构成比(77.55%vs 46.22%)、麻醉机过滤器重复使用构成比(89.80%vs 72.41%)、钠石灰使用<1次/d构成比(51.02%vs 25.66%)、七氟烷使用构成比87.76%vs 68.01%)比较,医院感染者均明显高于医院未感染者,差异均有统计学意义(P<0.05);建立多因素Logistic回归模型分析,结果显示,ASA分级>Ⅱ级、全麻方式、麻醉通气时间≥2 h、麻醉机过滤器重复使用是全身麻醉手术患者医院感染风险因素(P<0.05),钠石灰使用是全身麻醉手术患者医院感染保护性因素(P<0.05)。结论全身麻醉关于手术患者医院感染危险因素多种多样,并非单一因素所致;加强其危险因素监测,针对高危人群进行麻醉风险管理,利于降低医院感染率以及减少抗菌药物使用率。
Objective To study the risk factors and preventive measures of nosocomial infection in patients undergoing general anesthesia. Methods The clinical data of 618 patients undergoing general anesthesia in Fuling Central Hospital of Chongqing from December 2015 to January 2018 were retrospectively analyzed. The nosocomial infection status and risk factors of nosocomial infection after operation were observed, screened, analyzed and summarized. Combined with professional knowledge, a multi-factor Logistic stepwise regression model was established to analyze the meaningful variables. Results Among the 618 patients, 49 had nosocomial infections and the infection rate was 7.93%.There was no significant difference in the characteristics of the clinical and surgical data between 569 patients without nosocomial infections(uninfected patients) and 49 patients with nosocomial infections(infected patients), P>0.05. Compared with the uninfected patients, the infected patients had higher proportions in ASA classification>level Ⅱ(77.55%vs 30.23%), total intravenous anesthesia(69.39% vs 35.85%), anesthesia ventilation time≥2 h(77.55% vs 46.22%), repeated use of anesthesia machine filter(89.80% vs 72.41%), sodium lime use <1 time/d(51.02% vs 25.66%), sevoflurane use(87.76% vs 68.01%), with statistically significant difference(P<0.05). Multivariate logistic regression analysis showed that the risk factors of nosocomial infection in patients undergoing general anesthesia were ASA grade>Ⅱ grade,general anesthesia mode, anesthesia ventilation time≥2 h, and repeated use of anesthesia machine filters(P<0.05), and the use of sodium lime was the protective factor for nosocomial infection in patients undergoing general anesthesia(P<0.05). Conclusion The risk factors of nosocomial infection in patients undergoing general anesthesia are varied and not caused by a single factor. The monitoring of risk factors and the management of anesthesia risk for high-risk groups are conducive to reducing the rate of nosocomial infection and reducing the use of antimicrobial agents.
Objective To study the risk factors and preventive measures of nosocomial infection in patients undergoing general anesthesia. Methods The clinical data of 618 patients undergoing general anesthesia in Fuling Central Hospital of Chongqing from December 2015 to January 2018 were retrospectively analyzed. The nosocomial infection status and risk factors of nosocomial infection after operation were observed, screened, analyzed and summarized. Combined with professional knowledge, a multi-factor Logistic stepwise regression model was established to analyze the meaningful variables. Results Among the 618 patients, 49 had nosocomial infections and the infection rate was 7.93%.There was no significant difference in the characteristics of the clinical and surgical data between 569 patients without nosocomial infections(uninfected patients) and 49 patients with nosocomial infections(infected patients), P>0.05. Compared with the uninfected patients, the infected patients had higher proportions in ASA classification>level Ⅱ(77.55%vs 30.23%), total intravenous anesthesia(69.39% vs 35.85%), anesthesia ventilation time≥2 h(77.55% vs 46.22%), repeated use of anesthesia machine filter(89.80% vs 72.41%), sodium lime use <1 time/d(51.02% vs 25.66%), sevoflurane use(87.76% vs 68.01%), with statistically significant difference(P<0.05). Multivariate logistic regression analysis showed that the risk factors of nosocomial infection in patients undergoing general anesthesia were ASA grade>Ⅱ grade,general anesthesia mode, anesthesia ventilation time≥2 h, and repeated use of anesthesia machine filters(P<0.05), and the use of sodium lime was the protective factor for nosocomial infection in patients undergoing general anesthesia(P<0.05). Conclusion The risk factors of nosocomial infection in patients undergoing general anesthesia are varied and not caused by a single factor. The monitoring of risk factors and the management of anesthesia risk for high-risk groups are conducive to reducing the rate of nosocomial infection and reducing the use of antimicrobial agents.
引文
[1]刘仕欣,孙永勋,谭磊,等.骨髓间充质干细胞逆转支气管哮喘小鼠气道重构及其机制的初步研究[J].国际呼吸杂志, 2016, 3(2):81-85.
[2]柯玮玮,方洁.气管插管全身麻醉患者术后呼吸道感染的病原菌特点及危险因素分析[J].中国卫生检验杂志, 2019, 29(1):95-97.
[3]FEMANDEZ-BUSTAMANTE A, FRENDL G, SPRUNG J, et al.Postoperative pulmonary complications, early mortality, and hospital stay folowing noncardiothoracic surgery:a multicenter study by the perioperative research network investigators[J]. JAMA Surg, 2017,152(2):157-166.
[4]王俊,郑君刚,阮薏蒙,等.不同麻醉方式应用于急腹症合并脓毒性休克患者的临床效果比较[J].中华全科医学, 2017, 15(10):1684-1686.
[5]ALIAS D, RUIZ-TOVAR J, MORENO A, et al. Effect of subcutaneous sterile vitamin E ointment on incisional surgical site infection after elective laparoscopic colorectal cancer surgery[J]. Surg Infect,2017, 18(3):287-296.
[6]ABDELMALIK PA, RAKOCEVIC G. Propofol as a risk factor for ICU-acquired weakness in septic patients with acute respiratory failure[J]. Can J Neurol Sci, 2017, 44(3):295-303.
[7]周跃峰. 5S管理法用于麻醉科院内感染控制的效果[J].中医药管理杂志, 2018, 26(24):131-132.
[8]申茜.全身麻醉和腰-硬联合麻醉对术后医院感染及呼吸道的影响[J].河南外科学杂志, 2017, 4(5):129-135.
[9]中华人民共和国卫生部.医院感染诊断标准[S].北京:中华人民共和国卫生部, 2011.
[10]程旭娟,魏凌云,蒋臻,等.全身麻醉对骨科患者术后感染情况及炎症因子分析[J].中华医院感染学杂志, 2019, 29(3):422-424.
[11]陈波,朱丹,赵栋.多索茶碱对食管癌根治术患者氧化应激和炎症因子的影响[J].中华全科医学, 2018, 16(4):558-560.
[12]陶猛.麻醉后患者呼吸道感染发生情况及相关影响因素分析[J].中西医结合心血管病杂志, 2018, 6(23):81-82.
[13]ZHUANG J, YE J, HUANG Y, et al. Application of postoperational CT scan in the early diagnosis of incisional surgical site infections in elective colorectal surgery[J]. Int J Clin Exp Med, 2017, 10(7):9954-9962.
[14]SPADARO S, CARAMORI G, RIZZUTO C, et al. Expiratory flow limitation as a risk factor for pulmonary complications after major abdominal surgery[J]. Anesth Analg, 2017, 124(2):524-530.
[15]张永强,陈胜阳,刘俊,等.全身麻醉患者医院感染情况及危险因素[J].江苏预防医学, 2018, 323(1):72-78.
[16]陈波,彭文勇,屠文龙,等.右美托咪定对腹腔镜胃癌根治术患者氧化应激、糖代谢及术后镇痛的影响[J].中华全科医学, 2018, 16(3):395-397.
[17]BERRY M, PATEL BV, BRETT SJ. New consensus definitions for sepsis and septic shock:implications for treatment strategies and drug development?[J]. Drug, 2017, 77(4):353-361.
[18]王琰,张品,党萌,等.老年腹部手术患者全麻联合硬膜外麻醉的肺功能及肺部感染状况分析[J].中华医院感染学杂志, 2017, 27(19):4464-4467.
[2]柯玮玮,方洁.气管插管全身麻醉患者术后呼吸道感染的病原菌特点及危险因素分析[J].中国卫生检验杂志, 2019, 29(1):95-97.
[3]FEMANDEZ-BUSTAMANTE A, FRENDL G, SPRUNG J, et al.Postoperative pulmonary complications, early mortality, and hospital stay folowing noncardiothoracic surgery:a multicenter study by the perioperative research network investigators[J]. JAMA Surg, 2017,152(2):157-166.
[4]王俊,郑君刚,阮薏蒙,等.不同麻醉方式应用于急腹症合并脓毒性休克患者的临床效果比较[J].中华全科医学, 2017, 15(10):1684-1686.
[5]ALIAS D, RUIZ-TOVAR J, MORENO A, et al. Effect of subcutaneous sterile vitamin E ointment on incisional surgical site infection after elective laparoscopic colorectal cancer surgery[J]. Surg Infect,2017, 18(3):287-296.
[6]ABDELMALIK PA, RAKOCEVIC G. Propofol as a risk factor for ICU-acquired weakness in septic patients with acute respiratory failure[J]. Can J Neurol Sci, 2017, 44(3):295-303.
[7]周跃峰. 5S管理法用于麻醉科院内感染控制的效果[J].中医药管理杂志, 2018, 26(24):131-132.
[8]申茜.全身麻醉和腰-硬联合麻醉对术后医院感染及呼吸道的影响[J].河南外科学杂志, 2017, 4(5):129-135.
[9]中华人民共和国卫生部.医院感染诊断标准[S].北京:中华人民共和国卫生部, 2011.
[10]程旭娟,魏凌云,蒋臻,等.全身麻醉对骨科患者术后感染情况及炎症因子分析[J].中华医院感染学杂志, 2019, 29(3):422-424.
[11]陈波,朱丹,赵栋.多索茶碱对食管癌根治术患者氧化应激和炎症因子的影响[J].中华全科医学, 2018, 16(4):558-560.
[12]陶猛.麻醉后患者呼吸道感染发生情况及相关影响因素分析[J].中西医结合心血管病杂志, 2018, 6(23):81-82.
[13]ZHUANG J, YE J, HUANG Y, et al. Application of postoperational CT scan in the early diagnosis of incisional surgical site infections in elective colorectal surgery[J]. Int J Clin Exp Med, 2017, 10(7):9954-9962.
[14]SPADARO S, CARAMORI G, RIZZUTO C, et al. Expiratory flow limitation as a risk factor for pulmonary complications after major abdominal surgery[J]. Anesth Analg, 2017, 124(2):524-530.
[15]张永强,陈胜阳,刘俊,等.全身麻醉患者医院感染情况及危险因素[J].江苏预防医学, 2018, 323(1):72-78.
[16]陈波,彭文勇,屠文龙,等.右美托咪定对腹腔镜胃癌根治术患者氧化应激、糖代谢及术后镇痛的影响[J].中华全科医学, 2018, 16(3):395-397.
[17]BERRY M, PATEL BV, BRETT SJ. New consensus definitions for sepsis and septic shock:implications for treatment strategies and drug development?[J]. Drug, 2017, 77(4):353-361.
[18]王琰,张品,党萌,等.老年腹部手术患者全麻联合硬膜外麻醉的肺功能及肺部感染状况分析[J].中华医院感染学杂志, 2017, 27(19):4464-4467.