摘要
目的探讨重型颅脑损伤患者术后医院感染的影响因素。方法选取2014年5月—2016年5月中国人民解放军第180医院神经外科收治的重型颅脑损伤患者468例,根据术后医院感染发生情况分为医院感染组216例与非医院感染组252例。统计术后医院感染者例数及感染部位;收集所有患者临床资料,包括性别、年龄、手术风险评估分级、手术时间、入住重症监护室(ICU)时间、术后是否置管、术后置管时间、术后首次换药时间、是否使用胃管鼻饲、是否行气管插管或切开、呼吸机类型及是否予以早期肠内营养支持,重型颅脑损伤患者术后医院感染的影响因素分析采用多因素Logistic回归分析。结果 468例患者术后发生医院感染216例,术后医院感染发生率为46.15%;医院感染部位主要为呼吸系统,占49.23%;其次为泌尿系统,占18.15%。两组患者性别、是否使用胃管鼻饲比较,差异无统计学意义(P>0.05);两组患者年龄、手术风险评估分级、手术时间、入住ICU时间、术后是否置管、术后置管时间、术后首次换药时间、是否行气管插管或切开、呼吸机类型及是否予以早期肠内营养支持比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,年龄〔OR=1.281,95%CI(1.129,1.455)〕、手术时间〔OR=2.257,95%CI(1.132,4.500)〕、入住ICU时间〔OR=1.513,95%CI(1.229,1.908)〕、术后置管时间〔OR=1.988,95%CI(1.564,2.552)〕、术后首次换药时间〔OR=1.842,95%CI(1.402,2.603)〕、气管插管或切开〔OR=3.114,95%CI(1.201,8.077)〕及呼吸机类型〔OR=1.530,95%CI(1.299,3.635)〕是重型颅脑损伤患者术后医院感染的危险因素,早期肠内营养支持〔OR=0.662,95%CI(0.165,0.912)〕则是保护因素(P<0.05)。结论年龄、手术时间、入住ICU时间、术后置管时间、术后首次换药时间、气管插管或切开、呼吸机类型及早期肠内营养支持是重型颅脑损伤患者术后医院感染的�
Objective To investigate the influencing factors of postoperative nosocomial infection in patients with severe craniocerebral trauma. Methods From May 2014 to May 2016,a total of 180 patients with severe craniocerebral trauma were selected in the Department of Neurosurgery,the 180 th Hospital of Chinese People’s Liberation Army,and they were divided into A group（ complicated with nosocomial infection,n = 216） and B group（ did not complicate with nosocomial infection,n= 252） according to the incidence of postoperative nosocomial infection. Incidence of postoperative nosocomial infection and infection sites were recorded,and clinical data was collected,including gender,age,surgery risk assessment classification,duration of surgery, ICU stays, received catheterization or not after surgery, duration of postoperative catheterization, first dressing change time after surgery, received nasal feeding or not, received endotracheal intubation / tracheotomy or not,breathing machine types and received early enteral nutrition or not,meanwhile multivariate Logistic regression analysis was used to analyze the influencing factors of postoperative nosocomial infection in patients with severe craniocerebral trauma. Results The incidence of postoperative nosocomial infection was 46. 15%（ 216 /468）; respiratory system（ accounting for 49. 23%） and urinary system（ accounting for 18. 15%） were the major infection sites. No statistically significant differences of gender,receivednasal feeding or not was found between the two groups（ P 〉 0. 05）,while there were statistically significant differences of age,surgery risk assessment classification,duration of surgery,ICU stays,received catheterization or not after surgery,duration of postoperative catheterization, first dressing change time after surgery, received endotracheal intubation / tracheotomy or not,breathing machine types and received early enteral nutrition or not between the two groups（ P 〈 0. 05）. Multivariate Logistic regression analysis result
出处
《实用心脑肺血管病杂志》
2017年第1期39-42,共4页
Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease
基金
南京军区医学科技创新项目(MS102)
南京军区医药卫生科研基金课题(14MS093)
关键词
颅脑损伤
交叉感染
影响因素分析
Craniocerebral trauma
Cross infection
Root cause analysis
