急诊手术患者发生医院获得性肺炎与呼吸机相关肺炎的危险因素
|
摘要
目的探讨急诊手术患者医院获得性肺炎(HAP)与呼吸机相关肺炎(VAP)的危险因素,为降低医院感染发病率提供依据。方法回顾性调查某院2014年1月—2016年12月急诊手术和择期手术患者的临床资料,分析患者术后HAP与VAP的发病率及其病原菌分布,探究急诊手术患者HAP和VAP的危险因素。结果共选取急诊手术患者3 526例,发生医院感染123例次,医院感染例次发病率为3.49%;急诊手术患者发生HAP、VAP分别为55例次、20例次。共选取择期手术患者6 904例,发生医院感染192例次,医院感染例次发病率为2.78%;择期手术患者发生HAP、VAP分别为53例次、17例次;急诊手术的医院感染例次发病率、HAP和VAP发病率高于择期手术,差异均具有统计学意义(均P<0.05)。手术后患者HAP和VAP检出病原菌主要以革兰阴性菌为主。性别(男)、年龄(≥60岁)、昏迷、气管切开/气管插管、机械通气、联合使用抗菌药物、口腔护理、曾入住ICU、手术次数≥2次是急诊手术患者发生HAP的独立危险因素(均P<0.05);昏迷、手术次数≥2次是急诊手术患者发生VAP的独立危险因素(均P<0.05)。结论急诊手术患者的HAP与VAP的发病率较高,各有相关独立危险因素,应根据相关危险因素采取针对性预防控制措施。
Objective To explore risk factors for hospital-acquired pneumonia(HAP)and ventilator-associated pneumonia(VAP)in patients undergoing emergency surgery,provide evidence for reducing the incidence of healthcare-associated infection(HAI).Methods Clinical data of patients undergoing emergency and selective surgery in a hospital from January 2014 to December 2016 were surveyed retrospectively,incidence and distribution of pathogens of HAP and VAP after surgery were analyzed,risk factors for HAP and VAP in patients undergoing emergency surgery were analyzed.Results A total of 3 526 patients who underwent emergency surgery were selected,123 cases of HAI occurred,HAI case rate was 3.49%;55 cases of HAP and 20 cases of VAP occurred among patients undergoing emergency surgery.6 904 patients underwent selective surgery,192 cases of HAI occurred,HAI case rate was 2.78%;53 cases of HAP and17 cases of VAP occurred among patients undergoing selective surgery;HAI case rate,incidences of HAP and VAP in the emergency surgery were all higher than those of selective surgery,difference were all statistically significant(all P<0.05).Gram-negative bacteria were the main pathogens isolated from patients with HAP and VAP after surgery.Sex(male),age(≥60 years),coma,tracheotomy/tracheal intubation,mechanical ventilation,combined use of antimicrobial agents,oral care,history of staying in ICU,and the number of surgery≥2 times were independent risk factors for HAP in patients undergoing emergency surgery(all P<0.05);coma and the number of surgery≥2 times were independent risk factors for VAP in patients undergoing emergency surgery(both P<0.05).Conclusion Incidences of HAP and VAP are higher in patients undergoing emergency surgery,each has its own independent risk factors,targeted prevention and control measures should be taken according to the relevant risk factors.
Objective To explore risk factors for hospital-acquired pneumonia(HAP)and ventilator-associated pneumonia(VAP)in patients undergoing emergency surgery,provide evidence for reducing the incidence of healthcare-associated infection(HAI).Methods Clinical data of patients undergoing emergency and selective surgery in a hospital from January 2014 to December 2016 were surveyed retrospectively,incidence and distribution of pathogens of HAP and VAP after surgery were analyzed,risk factors for HAP and VAP in patients undergoing emergency surgery were analyzed.Results A total of 3 526 patients who underwent emergency surgery were selected,123 cases of HAI occurred,HAI case rate was 3.49%;55 cases of HAP and 20 cases of VAP occurred among patients undergoing emergency surgery.6 904 patients underwent selective surgery,192 cases of HAI occurred,HAI case rate was 2.78%;53 cases of HAP and17 cases of VAP occurred among patients undergoing selective surgery;HAI case rate,incidences of HAP and VAP in the emergency surgery were all higher than those of selective surgery,difference were all statistically significant(all P<0.05).Gram-negative bacteria were the main pathogens isolated from patients with HAP and VAP after surgery.Sex(male),age(≥60 years),coma,tracheotomy/tracheal intubation,mechanical ventilation,combined use of antimicrobial agents,oral care,history of staying in ICU,and the number of surgery≥2 times were independent risk factors for HAP in patients undergoing emergency surgery(all P<0.05);coma and the number of surgery≥2 times were independent risk factors for VAP in patients undergoing emergency surgery(both P<0.05).Conclusion Incidences of HAP and VAP are higher in patients undergoing emergency surgery,each has its own independent risk factors,targeted prevention and control measures should be taken according to the relevant risk factors.
引文
[1]邵红玉,汤磊雯,叶志弘.急诊手术安全管理的实践[J].中华护理杂志,2013,48(3):235-237.
[2]嵇晓红,张敏,刘胜初.重型颅脑损伤患者术后医院获得性肺炎的危险因素分析[J].广东医学,2013,34(3):430-432.
[3]黄妮妮,胡美春,韦思尊,等.呼吸机相关肺炎发病率及危险因素前瞻性研究[J].中国感染控制杂志,2016,15(11):845-848.
[4]孙来芳,陈大庆,孔万权,等.ICU急诊开颅术后患者医院感染的研究[J].中华医院感染学杂志,2015,25(9):2069-2071.
[5]Soutome S,Yanamoto S,Funahara M,et al.Effect of perioperative oral care on prevention of postoperative pneumonia associated with esophageal cancer surgery:a multicenter case-control study with propensity score matching analysis[J].Medicine(Baltimore),2017,96(33):e7436.
[6]Strobel RJ,Liang Q,Zhang M,et al.A preoperative risk model for postoperative pneumonia after coronary artery bypass grafting[J].Ann Thorac Surg,2016,102(4):1213-1219.
[7]Aydin C,Otan E,Akbulut S,et al.Postoperative pulmonary complications after liver transplantation:assessment of risk factors for mortality[J].Transplant Proc,2015,47(5):1488-1494.
[8]Li L,Yuan W,Zhang S,et al.Analysis of risk factors for pneumonia in 482 patients undergoing oral cancer surgery with tracheotomy[J].J Oral Maxillofac Surg,2016,74(2):415-419.
[9]Evaristo-Méndez G,Rocha-Calderón CH.Risk factors for nosocomial pneumonia in patients with abdominal surgery[J].Cir Cir,2016,84(1):21-27.
[10]Miki Y,Makuuchi R,Tokunaga M,et al.Risk factors for postoperative pneumonia after gastrectomy for gastric cancer[J].Surg Today,2016,46(5):552-556.
[11]中华人民共和国卫生部.肺炎诊断:WS382-2012[S].北京,2012.
[12]中华医学会重症医学分会.呼吸机相关性肺炎预防、诊断和治疗指南(2013)[J].中华内科杂志,2013,52(6):524-543.
[13]Fujita T,Sakurai K.Multivariate analysis of risk factors for postoperative pneumonia[J].Am J Surg,1995,169(3):304-307.
[14]Klompas M,Speck K,Howell MD,et al.Reappraisal of routine oral care with chlorhexidine gluconate for patients receiving mechanical ventilation:systematic review and metaanalysis[J].JAMA Inter Med,2014,174(5):751-761.
[15]中华医学会神经外科学分会颅脑创伤专业组,中华医学会创伤学分会神经损伤专业组.颅脑创伤长期昏迷诊治中国专家共识[J].中华神经外科杂志,2015,31(8):757-760.
[16]中华医学会神经外科学分会.神经外科重症管理专家共识(2013版)[J].中华医学杂志,2013,93(23):1765-1779.
[17]章洪院,孙耕耘.颅脑手术患者医院获得性肺炎危险因素及病原菌分析[J].中华医院感染学杂志,2013,23(3):549-551.
[18]Dobrick N,Müller N,Franzen D.Legionnaires disease(legionella pneumonia)[J].Praxis,2012,101(23):1459-1465.
[19]Hui X,Haider AH,Hashmi ZG,et al.Increased risk of pneumonia among ventilated patients with traumatic brain injury:every day counts![J].J Surg Res,2013,184(1):438-443.
[20]Vishwanath S,Chawla K,Gopinathan A.Multidrug resistant gram-negative bacilli in lower respiratory tract infections[J].Iran J Microbiol,2013,5(4):323-327.
[2]嵇晓红,张敏,刘胜初.重型颅脑损伤患者术后医院获得性肺炎的危险因素分析[J].广东医学,2013,34(3):430-432.
[3]黄妮妮,胡美春,韦思尊,等.呼吸机相关肺炎发病率及危险因素前瞻性研究[J].中国感染控制杂志,2016,15(11):845-848.
[4]孙来芳,陈大庆,孔万权,等.ICU急诊开颅术后患者医院感染的研究[J].中华医院感染学杂志,2015,25(9):2069-2071.
[5]Soutome S,Yanamoto S,Funahara M,et al.Effect of perioperative oral care on prevention of postoperative pneumonia associated with esophageal cancer surgery:a multicenter case-control study with propensity score matching analysis[J].Medicine(Baltimore),2017,96(33):e7436.
[6]Strobel RJ,Liang Q,Zhang M,et al.A preoperative risk model for postoperative pneumonia after coronary artery bypass grafting[J].Ann Thorac Surg,2016,102(4):1213-1219.
[7]Aydin C,Otan E,Akbulut S,et al.Postoperative pulmonary complications after liver transplantation:assessment of risk factors for mortality[J].Transplant Proc,2015,47(5):1488-1494.
[8]Li L,Yuan W,Zhang S,et al.Analysis of risk factors for pneumonia in 482 patients undergoing oral cancer surgery with tracheotomy[J].J Oral Maxillofac Surg,2016,74(2):415-419.
[9]Evaristo-Méndez G,Rocha-Calderón CH.Risk factors for nosocomial pneumonia in patients with abdominal surgery[J].Cir Cir,2016,84(1):21-27.
[10]Miki Y,Makuuchi R,Tokunaga M,et al.Risk factors for postoperative pneumonia after gastrectomy for gastric cancer[J].Surg Today,2016,46(5):552-556.
[11]中华人民共和国卫生部.肺炎诊断:WS382-2012[S].北京,2012.
[12]中华医学会重症医学分会.呼吸机相关性肺炎预防、诊断和治疗指南(2013)[J].中华内科杂志,2013,52(6):524-543.
[13]Fujita T,Sakurai K.Multivariate analysis of risk factors for postoperative pneumonia[J].Am J Surg,1995,169(3):304-307.
[14]Klompas M,Speck K,Howell MD,et al.Reappraisal of routine oral care with chlorhexidine gluconate for patients receiving mechanical ventilation:systematic review and metaanalysis[J].JAMA Inter Med,2014,174(5):751-761.
[15]中华医学会神经外科学分会颅脑创伤专业组,中华医学会创伤学分会神经损伤专业组.颅脑创伤长期昏迷诊治中国专家共识[J].中华神经外科杂志,2015,31(8):757-760.
[16]中华医学会神经外科学分会.神经外科重症管理专家共识(2013版)[J].中华医学杂志,2013,93(23):1765-1779.
[17]章洪院,孙耕耘.颅脑手术患者医院获得性肺炎危险因素及病原菌分析[J].中华医院感染学杂志,2013,23(3):549-551.
[18]Dobrick N,Müller N,Franzen D.Legionnaires disease(legionella pneumonia)[J].Praxis,2012,101(23):1459-1465.
[19]Hui X,Haider AH,Hashmi ZG,et al.Increased risk of pneumonia among ventilated patients with traumatic brain injury:every day counts![J].J Surg Res,2013,184(1):438-443.
[20]Vishwanath S,Chawla K,Gopinathan A.Multidrug resistant gram-negative bacilli in lower respiratory tract infections[J].Iran J Microbiol,2013,5(4):323-327.