神经外科手术患者医院感染及危险因素分析

Healthcare-associated infection and risk factors in patients undergoing neurosurgical operation

目的探讨神经外科手术患者发生医院感染的情况及相关危险因素，为预防术后感染提供理论依据。方法回顾性调查某院2 496例神经外科手术患者临床资料，进行单因素和多因素logistic回归分析，分析手术患者发生医院感染的可能危险因素。结果2 496例手术患者发生医院感染421例，447例次，医院感染率为16.87%，例次率为17.91%；医院感染的主要部位为手术部位（42.06%，188例），其次是下呼吸道（33.56%,150例）和泌尿道（10.51%,47例）等。单因素分析结果显示,年龄、原发疾病、手术持续时间、气管插管/切开、输血、术后二次手术、术前高血糖7项因素是神经外科手术患者医院感染相关危险因素（均P＜0.05）；logistic回归分析结果表明，年龄≥60岁（OR 95% CI：1.19～2.06）、手术时间≥3 h（OR 95% CI：1.61～2.87）、气管插管/切开（OR 95% CI：2.90～5.50）、输血（OR 95% CI：1.58～2.63）及术前高血糖（OR 95% CI：1.52～2.79）是神经外科手术患者医院感染的独立危险因素。结论神经外科手术患者医院感染的发生与多种因素有关，应加强医院感染的监测，重视各环节的质量控制。

ObjectiveTo evaluate the risk factors of healthcareassociated infection（HAI） in patients undergoing neurosurgical operation, and provide reference for preventing postoperative infection.MethodsClinical data of 2 496 patients undergoing neurosurgical operation were analyzed, univariate analysis and multivariate logistic regression analysis on risk factors for HAI were performed.ResultsOf 2 496 patients, 421 developed 447 episodes of HAI, HAI rate and case rate was 16.87% and 17.91% respectively; the main infection site was surgical site（42.06%，188 cases）,followed by lower respiratory tract（33.56%,150 cases） and urinary tract（10.51%,47 cases）. Univariate analysis showed that the related risk factors for postoperative infection were age, primary diseases, duration of operation, tracheal intubation/tracheotomy, blood transfusion, a second operation, preoperative hyperglycemia（all P＜0.05）. Multivariate logistic regression analysis showed that age≥60 years old（OR 95% CI：1.19-2.06）,duration of operation ≥3 hours（OR 95% CI：1.61-2.87）, tracheal intubation/tracheotomy（OR 95% CI：2.90-5.50）, blood transfusion（OR 95% CI：1.58-2.63）, and preoperative hyperglycemia（OR 95% CI：1.52-2.79） were independent risk factors for infection in patients undergoing neurosurgical operation.ConclusionThe occurrence of HAI in patients undergoing neurosurgical operation is related to multiple factors, surveillance on HAI should be intensified.