腹腔镜胆囊切除术医院感染危险因素及防治策略

Risk factors for laparoscopic cholecystectomy-induced nosocomial infections and the prevention countermeasures

目的探讨腹腔镜胆囊切除术后医院感染的危险因素和防治措施,以减少术后医院感染的发生。方法选取2005年1月-2011年12月1294例在医院行腹腔镜胆囊切除术患者的资料,对出现医院感染患者的影响因素进行回顾性分析。结果 1294例行腹腔镜胆囊切除手术患者中共有42例患者出现医院感染,感染率为3.25%,腹腔内感染最高,16例占38.1%;腹腔镜胆囊切除术后医院感染与年龄、性别、住院时间、胆囊病变类型及术中失血量无关,而与患者是否合并基础疾病、手术时间、胆囊破裂与否、脂肪厚度显著相关,差异有统计学意义(P<0.05)。结论围手术期加强患者基础疾病的控制,术中熟练操作缩短手术时间,积极控制胆囊急性炎症及选择更为合适的手术时机可减少医院感染的发生。

OBJECTIVE To analyze the risk factors for laparoscopic cholecystectomy-induced nosocomial infections and to put forward the prevention countermeasures so as to reduce the incidence of postoperative infections. METHODS The clinical data of 1294 cases of patients who underwent laparoscopic cholecystectomy from Jan 2005 to Dec 2011 were reviewed. The influencing factors for the laparoscopic cholecystectomy-induced nosocomial infections were analyzed retrospectively. RESULTS Of totally 1294 cases of patients undergoing laparoscopic cholecystectomy, the nosocomial infections occurred in 42 cases with the infection rate of 3.25%, among which there were 16 （38.1%） cases of patients with intra-abdominal infections. The incidence of nosocomial infections after the laparoscopic cholecystectomy was significantly related to the underlying disease, operation duration, rupture gallbladder, and fat thickness （P〈0.05）, and was negatively correlated with the age, gender,hospitalization duration,cystic lesion type or intraoperative blood loss. CONCLUSION Strengthening the control of underlying diseases during the perioperative period,improving the operation skills to shorten the surgery duration, actively controlling gallbladder acute inflammation and choosing more appropriate time for the surgery can reduce the incidence of nosoeomial infections.