急性心肌梗死患者医院感染危险因素分析

The nosocomial infection risk factors analysis in patients with acute myocardial infarctionThe nosocomial infection risk factors analysis in patients with acute myocardial infarction

目的分析急性心肌梗死（AMI）患者医院感染的特点及相关危险因素，探讨降低其医院感染发生率的防控措施。方法回顾性调查分析2008年1月至2010年12月循环内科收治的289例急性心肌梗死患者的临床资料。结果共发生医院感染46例，51例次，感染发生率15．92％，例次感染率17．65％；感染部位以呼吸道为主，占52．94％，其他依次为泌尿道（17．65％）、胃肠道（13．73％）等；检出的病原菌以G-杆菌为主，占51．43％，G＋球菌占34．29％，真菌占11．43％；高龄、心功能不全（Ⅲ～Ⅳ级）、住院时间长、合并其他疾病、侵人性操作、预防性应用抗菌药物、多壁心肌梗死等是发生医院感染的危险因素。结论急性心肌梗死患者医院感染发生率高，危险因素多。加强基础疾病治疗、纠正心力衰竭、对高龄患者密切监测、缩短住院时间、减少侵入性操作、合理应用抗菌药物等是降低急性心肌梗死患者医院感染发生的有效措施。

Objective Analysis of the nosocomial infection characteristics and related risk factors in patients with acute myocardial infarction （AMI）, and explore the prevention and control measures of hospital infection. Methods Retrospective analysis the clinical data of 289 patients with acute myocardial infarction admitted in Circulation department from January 2008 to December 2010. Results There were 46 eases with 51 times of hospital infection, the infection rate was 15.92%, case time infection rate was 17.65%. The respiratory tract infection was account for 52.94%, followed was urinary tract （17.65%）, gastrointestinal tract （13.73%）. In the pathogens, the accounting of G- baciUi was 51.43%, G＋ cocci was 34.29%, fungi was 11.43%. Old age, heart function insufficiency （NYHA Ⅲ to Ⅳ grade）, long hospital stay, associated with other diseases, invasive procedures, the preventive use of antimicrobial drugs, multi-wall myocardial infarction were the risk factors for nosocomial infection. Conclusion In patients with acute myocardial infarction, the nosocomial infection is high incidence, especially in patients with high risk factors. Strengthening the basic disease therapy, improving heart failure, closely monitoring of elderly patients, shorter hospital stays, reducing invasive procedures and the rational use of antimicrobial drugs are the measures to lower nosocomial infection in patients with acute myocardial infarction.