心脏外科重症监护病房医院感染的临床探讨

Investigation of nosocomial infections after cardiac surgery in cardiac intensive care unit

目的研究心外科重症监护病房(CICU)中医院感染的发生情况。方法选取我科2002年1月至2004年12月收治1 263例心脏手术后患者,对术后医院感染发生率和不同病种、手术方式、手术时间、CICU入住时间与医院感染发生关系以及细菌学培养结果进行统计学分析。结果大血管组及冠心组术后医院感染发生率分别为52.3%和26.2%,明显高于风心组与先心组,呼吸系统感染发生率为4.9%,高于其他系统医院感染的发生率,体外循环术后医院感染率13.2%,高于非体外循环术后感染率6.2%(P<0.01)。手术时间长于4 h者,术后医院感染的发生率为39.3%,高于手术时间小于4 h者(P<0.01)。术后CICU中住院达1周以上者术后发生医院感染率约为58.4%,远高于术后CICU中住院日期小于1周者(P<0.001)。结论体外循环术后、手术时间大于4 h及在心外重症监护病房内时间超过1周者医院感染的发生率高,对此类患者注意防止医院感染的发生。

Objective To investigate the prevalence and risk factors of nosocomial infections in cardiac intensive care unit. Meth- ods From January 2002 to December 2004, 1 263 patients who received heart operation were admitted to cardiac CICU. The nosocomial infection rate after cardiac surgery was analyzed in relation to disease category, type of operation, duration of operation, and length of CICU stay. Results Infection rate was higher in vascular and coronary groups （52.3% and 26.2% respectively） in comparison with other groups. The most common infection was pulmonary infection （4. 9%）. The infection was more frequent in patients receiving cardiopulmonary bypass operation （13.2% vs. 6.2%, P〈0.01 ）. The patients with duration of operation 〉 4 hours had higher incidence of nosocomial infection （39.3 %） compared with those whose duration of operation was less than 4 hours （P〈0.01）. The group with postoperative CICU stay 〉 1 week had more infection when compared to the group with postoperative CICU stay 〈1 week （58.4% vs. 5.3% P〈0. 001）. Conclusions The nosocomial infection rate after cardiac surgery is related to disease category, duration of operation, length of CICU stay and cardiopulmonary bypass operation. In order to lower the nosocomial infection rate, such risk factors should be controlled.