神经外科手术患者医院感染目标性监测分析

发布时间：2018-07-01 09:00

本文选题：神经外科 + 手术患者　；参考：《中华医院感染学杂志》2014年07期

【摘要】：目的分析神经外科手术患者术后医院感染相关危险因素,探讨预防控制对策以降低医院感染率。方法目标性监测2011年5月-2012年11月神经外科住院择期和急诊的脑肿瘤、脑积水、颅骨修补、脊髓疾病等疾病1 862例实施手术患者临床资料,分析结果反馈临床,提出干预对策,采用SPSS15.0软件进行数据分析。结果神经外科1 862例手术患者发生医院感染222例、249例次,感染率11.32%、例次感染率13.37%;其中脑肿瘤术后感染率15.83%,脑积水分流术后感染率11.83%;感染部位以下呼吸道为主占42.97%,其次为颅内占41.37%、泌尿道12.45%;分离出病原菌149株,前3位为肺炎克雷伯菌、铜绿假单胞菌、金黄色葡萄球菌,分别占18.79%、14.77%、10.74%;单因素分析和logistic回归分析显示,年龄、手术时间、手术类型、伤口清洁度、术前外周白细胞数、气管切开、颅内置管、植入物、预防应用抗菌药物和住院时间是主要独立危险因素。结论神经外科手术后医院感染率较高,应尽量缩短住院天数和手术时间,加强急诊手术和无菌物品管理,严格执行无菌操作,合理使用抗菌药物,加强手术患者的全程管理。
[Abstract]:Objective to analyze the risk factors of nosocomial infection in patients undergoing neurosurgery, and to explore the preventive and control measures to reduce the nosocomial infection rate. Methods from May 2011 to November 2012, 1 862 patients with neurosurgical diseases, including selective and emergency brain tumors, hydrocephalus, cranial repair and spinal cord diseases, were monitored. SPSS 15.0 software was used for data analysis. Results among 1 862 cases of neurosurgery, 222 cases had nosocomial infection and 249 cases had nosocomial infection. The infection rate was 11.32%, the infection rate was 13.37%. Among them, the postoperative infection rate of brain tumors was 15.83%, and the infection rate of hydrocephalus shunt was 11.833%. The respiratory tract below the infection site was mainly occupied by 42.97%, followed by the intracranial portion of 41.37 and the urinary tract 12.45%. 149 strains of pathogenic bacteria were isolated, and the first three were Klebsiella pneumoniae. Pseudomonas aeruginosa and Staphylococcus aureus accounted for 18.79 ~ 14.777.74, respectively. Univariate analysis and logistic regression analysis showed that age, operation time, surgical type, wound cleanliness, preoperative peripheral white blood cell count, tracheotomy, intracranial catheterization, implants, Prophylactic use of antimicrobial agents and length of stay were the main independent risk factors. Conclusion the nosocomial infection rate after neurosurgery is high, the hospital stay and operation time should be shortened as far as possible, the management of emergency operation and aseptic items should be strengthened, the aseptic operation should be strictly carried out, the antibiotics should be used rationally, and the management of the whole process of operation should be strengthened.
【作者单位】：苏州大学附属第一医院感染管理科;
【基金】：江苏省苏州市科技计划基金资助项目(2012SYS60);江苏省苏州市科技计划基金项目(2003SZD0344)
【分类号】：R181.32

【参考文献】