胃大部切除术患者医院感染的影响因素及预防对策
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摘要
目的探讨胃大部分切除术患者发生医院感染的影响因素并提出相应预防对策。方法回顾性调查在2012年3月-2016年3月于医院进行胃大部切除术治疗的2 480例患者的临床资料,调查患者住院期间医院感染的发生情况,并分析相关影响因素,总结预防对策。结果本研究2 480例患者共150例发生医院感染,感染率为6.05%,其中感染部位以尿路感染最为多见,占38.67%,150例感染患者共分离病原菌168株,其中革兰阳性菌42株(25.00%),革兰阴性菌80株(47.62%),真菌46株(27.38%);经单因素分析,患者的年龄、住院时间、侵入性操作、留置尿管时间、抗菌药物种类、恶性肿瘤、激素的使用、基础疾病以及白细胞计数与胃大部切除术患者发生医院感染具有相关性(P<0.05),对医院感染相关影响因素进行多因素Logstic回归分析,结果显示,患者的年龄、留置尿管时间、侵入性操作以及白细胞计数是造成胃大部切除术患者发生医院感染的独立影响因素。结论患者的年龄、留置尿管时间、侵入性操作以及白细胞计数是造成胃大部切除术患者发生医院感染的独立影响因素,需给予相应干预对策以降低医院感染的发生率。
OBJECTIVE To explore the influencing factors for nosocomial infection in patients undergoing subtotal gastrectomy and put forward the targeted prevention countermeasures.METHODS The clinical data of 2480 patients who underwent the subtotal gastrectomy in the hospital from Mar 2012 to Mar 2016 were retrospectively analyzed,the incidence of nosocomial infection was analyzed during the hospital stay,the univariate analysis and multivariate logistic regression analysis were performed for the influencing factors for the nosocomial infection,and the prevention countermeasures were put forward.RESULTS Of the 2480 patients,150 had nosocomial infection,with the infection rate 6.05%,38.67% of whom had urinary tract infection.A total of 168 strains of pathogens were isolated from the 150 patients with infection,42(25.00%)of which were gram-positive bacteria,80(47.62%)were gram-negative bacteria,and 46(27.38%)were fungi.The univariate analysis showed that the incidence of nosocomial infection in the subtotal gastrectomy patients was associated with age,length of hospital stay,invasive operation,urinary catheter indwelling time,types of antibiotic,malignant tumor,use of hormones,underlying disease and white blood cell counts(P<0.05).The result of the multivariate logistic regression analysis indicated that the age,urinary catheter indwelling time,invasive operation and white blood cell counts were the independent influencing factors for the nosocomial infection in the subtotal gastrectomy patients.CONCLUSIONThe age,urinary catheter indwelling time,invasive operation and white blood cell counts are the independent influencing factors for the nosocomial infection in the subtotal gastrectomy patients.It is necessary to take targeted intervention measures so as to reduce the incidence of nosocomial infection.
OBJECTIVE To explore the influencing factors for nosocomial infection in patients undergoing subtotal gastrectomy and put forward the targeted prevention countermeasures.METHODS The clinical data of 2480 patients who underwent the subtotal gastrectomy in the hospital from Mar 2012 to Mar 2016 were retrospectively analyzed,the incidence of nosocomial infection was analyzed during the hospital stay,the univariate analysis and multivariate logistic regression analysis were performed for the influencing factors for the nosocomial infection,and the prevention countermeasures were put forward.RESULTS Of the 2480 patients,150 had nosocomial infection,with the infection rate 6.05%,38.67% of whom had urinary tract infection.A total of 168 strains of pathogens were isolated from the 150 patients with infection,42(25.00%)of which were gram-positive bacteria,80(47.62%)were gram-negative bacteria,and 46(27.38%)were fungi.The univariate analysis showed that the incidence of nosocomial infection in the subtotal gastrectomy patients was associated with age,length of hospital stay,invasive operation,urinary catheter indwelling time,types of antibiotic,malignant tumor,use of hormones,underlying disease and white blood cell counts(P<0.05).The result of the multivariate logistic regression analysis indicated that the age,urinary catheter indwelling time,invasive operation and white blood cell counts were the independent influencing factors for the nosocomial infection in the subtotal gastrectomy patients.CONCLUSIONThe age,urinary catheter indwelling time,invasive operation and white blood cell counts are the independent influencing factors for the nosocomial infection in the subtotal gastrectomy patients.It is necessary to take targeted intervention measures so as to reduce the incidence of nosocomial infection.
引文
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[2]王恒恩,陈玉辉,裴艳蕾,等.术前不同营养状态对胃大部切除术后患者感染风险的影响[J].中国临床医生杂志,2017,45(4):65-68.
[3]白秀丽,杨玄,王玉玲,等.个性化中医护理模式对胃大部切除患者的护理效果[J].中国实用护理杂志,2017,33(3):165-168.
[4]徐皓,汪未知,李沣员,等.胃癌根治术后特殊外科并发症的预防要点[J].中华胃肠外科杂志,2017,20(2):152-155.
[5]Ozalp N,Zulfikaroglu B,Gocmen E,et al.Risk factors for surgical site infection after gastrectomy with D2lymphadenectomy[J].Surg Today,2009,39(11):1013.
[6]中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.
[7]Vigil HR,Mallick R,Nitti VW,et al.Risk factors for urinary tract infection following midurethral sling surgery[J].J Urol,2017,197(5):1268.
[8]田河,宋静,邸彦橙,等.导尿管相关尿路感染危险因素分析[J].中国公共卫生,2016,32(3):373-374.
[9]付敏,陈前进.泌尿外科尿路感染危险因素分析及护理措施[J].检验医学与临床,2016,13(z1):122-124.
[10]温剑艺,覃铁和,王首红,等.老年人监护室导尿管相关尿路感染危险因素分析[J].中华老年医学杂志,2017,36(1):64-67.
[11]刘绍虔,米其武,张志刚.经尿道前列腺等离子双极电切术后尿路感染及其危险因素分析[J].西部医学,2015,27(2):252-254.
[12]杨青兰,曾登芬.国外导管相关性尿路感染防控现状及对我国的启示[J].护理管理杂志,2015,15(2):101-103.
[13]Zhong H,Zhou Z,Liu J,et al.Letter to the Editor concerning"risk factors for surgical site infection and urinary tract infection after spine surgery"by Tominaga,H,Setoguchi,T,Ishidou,Y,Nagano,S,Yamamoto,T,Komiya S(2016)Eur Spine J;doi:10.1007/s00586-016-4674-2[J].Eur Spine J,2016,25(12):1-1.
[14]Guglietta A.Recurrent urinary tract infections in women:risk factors,etiology,pathogenesis and prophylaxis[J].Future Microbiol,2017,12(3):239.