神经外科手术患者医院感染危险因素分析

Risk factors for nosocomial infections in patients of department of neurosurgery

目的研究神经外科手术患者医院感染的危险因素,为有效预防医院感染提供依据。方法对2010年1月-2012年12月8 530例神经外科手术患者进行回顾性和前瞻性调查,通过单因素分析筛选有统计学意义的变量,纳入多元logistic回归分析,分析神经外科手术患者医院感染的危险因素,使用软件MATLAB7.1、SPSS17.0和SAS进行统计分析。结果 3年内神经外科手术患者出院患者8 530例,感染476例、659例次,医院感染率为5.58%、例次感染率为7.73%;单因素logistic回归分析显示,年龄、基础疾病、院外感染、原发疾病、手术时长、麻醉方式、手术方式、中心静脉插管、泌尿插管、呼吸机、使用气管插管、气管切开、胃管鼻饲、感染前ICU天数是医院感染的危险因素;多元logistic回归分析结果显示,年龄≥60岁、基础疾病、院外感染、脑积水、手术时长>3h、泌尿道插管、呼吸机、气管切开、胃管鼻饲、开颅手术、内镜手术是神经外科手术患者医院感染的独立危险因素(P<0.05)。结论神经外科医院感染率较高,应加强对其医院感染监测,针对危险因素采取有效预防控制措施。

OBJECTIVE To study the risk factors for nosocomial infections in the patients of department of neuro- surgery so as to provide basis for effective prevention of nosocomial infections. METHODS A retrospective and pro- spective survey was conducted for 8530 patients who underwent surgery in the department of neurosurgery from Jan 2010 to Dec 2012, then the univariate analysis was performed to screen out the variables with statistical signif- icance, which were then included in the multivariate logistic regression analysis; the risk factors for the nosocomial infections were analyzed, and the statistical analysis was performed with the use of MATLAB7.1 and SPSS17.0 software as well as SAS. RESULTS Of totally 8530 patients who were discharged from the department of neurosur- gery in three years, the infections occurred in 476 cases （659 case-times ） with the infection rate of 5.58% and the case-time infection rate of 7.73 %. The univariate logistic regression analysis indicated that the age, underlying dis- ease, courtyard infection, primary disease, long operation duration, anesthesia approach, surgery approach, cen- tral venous catheterization, urinary catheterization, use of endotracheal catheter, ventilator, tracheotomy, naso- gastric tube, and length of ICU stay before infections were the risk factors for the nosocomial infections; the result of the multivariate logistic regression analysis showed that the more than 60 years of age, underlying diseases, courtyard infection, hydrocephalus, operation duration more than 3 hours, urinary catheterization, ventilator, tracheotomy, nasogastric tube, craniotomy, and endoscopic surgery were the independent risk factors for the nos- ocomial infections in the patients of department of neurosurgery （P〈0.05）. CONCLUSION The incidence of the nosocomial infections is high in the department of neurosurgery, and it is necessary to strengthen the monitoring ofthe patients with nosocomial infections and take effective prevention measures according to the risk factors.