急性心肌梗死患者医院感染的危险因素及护理对策

Risk factors and nursing measurement for nosocomial infection in patients with acute myocardial infarction

目的了解急性心肌梗死(AMI)住院患者医院感染发生情况,分析相关危险因素,探讨预防对策。方法采用回顾性调查方法,对2007年1月-2010年6月入住心血管内科的420例AMI患者的临床资料进行统计分析,内容包括年龄、性别、住院时间、合并其他疾病、心功能情况、有否入住冠心病重症监护病房(CCU)、介入手术、心肌梗死部位、抗菌药物应用等。结果共发生医院感染62例,总发生率14.8%;医院感染部位以呼吸道最为常见,占59.7%,其次是泌尿道12.9%,胃肠道11.3%,口腔9.7%,穿刺部位6.4%;单部位感染46例,2个部位感染12例,≥3个部位感染4例;病原学送检查,标本阳性率为68.6%,检出病原菌以革兰阴性杆菌为主占74.3%,革兰阳性球菌占20.0%,真菌占5.7%;医院感染危险因素包括高龄,住院时间较长,合并高血压、糖尿病、肺部疾病、脑血管病变、肾功能不全,入住CCU,心功能情况、多壁心肌梗死。结论 AMI患者医院感染发生率高,应引起高度重视,制定和完善医院感染防止规范、加强基础护理、保护易感染人群、合理使用抗菌药物等是降低AMI患者医院感染发生率的有效措施。

OBJECTIVE To investigate the nosocomial infection in acute myocardial infarction（AMI） patients and to analyze the related risk factors,and discuss the nursing measurement.METHODS The clinical data,such as age,gender,length of stay,coexistent diseases,heart function,CCU records,intervention treatment,infarction region and adoption of antibacterial,of 420 AMI patients who were admitted to hospital between Jan.2007 and Jun.2010 were retrospectively studied.RESULTS There were 62 infection cases,accounting for 14.8% of all the investigated cases.The most common infection sites were respiratory tract（59.7%）,followed by urinary tract（12.9%）,gastrointestinal tract（11.3%）,oral cavity（9.7%）,puncture region（6.4%）.46 cases single-site infection,12 with double site infection and 4 were with triple sites infection.the pathogenic examination,with 68.6% of positive rates mainly due to Gram-negative bacilli（74.3%）,Gram-positive cocci（20.0%）,fungi（5.7%）.The risk factors were： the advanced age,long hospital stay,coexistent HBP,diabetes,cerebrovascular disease,renal inadequacy,CCU stay,heart function and multitude walls myocardial infarction.CONCLUSION Nosocomial infection in AMI patients should be much stressed for its high incidence.The effective countermeasures include：establishing and improving the regulations for prevention of nosocomial infection,enhancing the basic nursing to protect susceptible patients and rationally adopting antibiotics.