摘要
目的探讨肝胆胰腺手术患者发生医院感染的影响因素与预防措施。方法回顾性分析2012年1月-2018年6月于南阳市第二人民医院行肝、胆、胰腺手术患者742例的临床资料,统计患者术后医院感染情况,分析患者性别、年龄、糖尿病、肝功能、术前使用抗菌药物等情况,归纳肝胆胰腺手术患者术后医院感染的影响因素。结果肝胆胰腺手术患者术后感染率为6.06%(45/742),感染部位以手术切口和下呼吸道为主;共培养分离病原菌79株,其中革兰阴性菌43株占54.43%,革兰阳性菌33株占41.77%,真菌3株占3.80%;以大肠埃希菌、肺炎克雷伯菌、金黄色葡萄球菌和表皮葡萄球菌为主。糖尿病、Hb、引流管留置时间、手术风险分级标准(NNIS)评分是肝胆胰腺手术患者术后医院感染的影响因素(P<0.001)。结论肝胆胰腺手术操作较复杂,术后易发生医院感染,影响患者术后医院感染的影响因素较多,临床工作中应根据患者具体情况,分析存在的风险因素,采取措施,积极预防。
OBJECTIVE To discuss the risk factors and preventive measures of nosocomial infection after hepatobiliary and pancreatic surgery.METHODS The clinical data of 732 patients who underwent liver,biliary and pancreatic surgery in the Nanyang Second People’s Hospital Nanyang from Jan.2012 to Jun.2018 were retrospectively analyzed.The postoperative nosocomial infections of the patients were recorded,and their gender,age,diabetes mellitus,liver function,as well as preoperative use of antimicrobial drugs were analyzed.The risk factors of postoperative nosocomial infection after hepatobiliary and pancreatic surgery were summarized.RESULTS Totally 45 cases were infected after hepatobiliary and pancreatic surgery among the 742 patients,and the infection rate was 6.06%.The dominant infection sites were surgical incision and lower respiratory tract infection.79 strains of pathogens were isolated from the 45 infected patients.Among them,Gram-negative bacteria were the most common(43 strains),accounting for 54.43%,followed by Gram-positive bacteria(33 strains),accounting for 41.77%.Escherichia coli,Klebsiella pneumoniae,Staphylococcus aureus and Staphylococcus epidermidis were the main pathogens.Diabetes,Hb,drainage tube retention time and the National Nosocomial Infections Surveillance(NISS)score were independent risk factors affecting postoperative nosocomial infection in patients who underwent hepatobiliary and pancreatic surgery(P<0.001).CONCLUSION The operation of hepatobiliary and pancreatic surgery is complicated,postoperative nosocomial infection is easy to occur,and there are many risk factors affecting postoperative nosocomial infection.In clinical work,the high-risk factors should be analyzed according to the specific conditions of patients,and measures should be taken to prevent them.
作者
尚伟伟
司华
赵红云
李金旭
王红雷
陈喜全
SHANG Wei-wei;SI Hua;ZHAO Hong-yun;LI Jin-xu;WANG Hong-lei;CHEN Xi-quan(Nanyang Second People's Hospital,Nanyang,Henan 473000,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2019年第19期2986-2989,共4页
Chinese Journal of Nosocomiology
基金
河南省科技攻关计划基金资助项目(2014098234)
关键词
肝胆胰腺手术
医院感染
影响因素
预防措施
Hepatobiliary and pancreatic surgery
Nosocomial infection
Influencing factors
Preventive measures
