心外科手术患者术后院内感染危险因素分析与防治对策

Analysis of risk factors for postoperative nosocomial infection in patients received cardiac surgery and its prevention countermeasures

目的研究心外科手术患者术后院内感染危险因素与防治对策。方法选择2007年1月-2009年6月在解放军总医院（以下简称“我院”）接受心外科手术的患者进行回顾性研究，分析感染危险因素；选择2009年7月～2012年12月在我院接受心外科手术的患者进行前瞻性研究，并给予感染综合防治措施，观察综合防治措施的效果。结果①不同年龄、手术持续时间、胸腔引流时间、气管插管时间、导尿管留置时间、预防性使用抗生素情况的患者，术后院内感染发生率差异有统计学差异（P〈0．05）；②年龄、手术持续时间、胸腔引流时间、气管插管时间、导尿管留置时间是发生术后院内感染的危险因素，预防性使用抗生素是术后院内感染的保护因素（P〈0．05）；③采取感染综合防治措施后，上呼吸道感染、下呼吸道感染、胃肠道感染、泌尿道感染以及切口感染的发生率均低于采取感染综合防治措施前，差异有统计学意义（P〈0．05）。结论高龄、未预防性使用抗生素以及手术持续时间、胸腔引流时间、气管插管时间、导尿管留置时间较长是术后院内感染发生的危险因素，在给予感染综合防治措施后能够有效控制感染发生率。

Objective To study the risk factors for postoperative nosocomial infection in patients received cardiac surgery and its prevention countermeasures. Methods Patients in General Hospital of PLA （＂our hospital＂ for short） from January 2007 to June 2009 were retrospectively studied. Then risk factors of infection were analyzed. Patients received cardiac surgery from July 2009 to December 2012 were prospectively studied and given comprehensive pre- vention and control measures, effects of prevention countermeasures were observed. Results ①Patients with different age, operation time, chest drainage time, intubation time, indwelling catheter time and prophylactic use of antibiotics had statistically significant in nosocomial infection rates （P 〈 0.05）. ②Age, operation time, chest drainage time, intuba- tion time, indwelling catheter time were the risk factors of nosocomial infection, preventive use of antibiotics was the protective factor of nosocomial infection （P 〈 0.05）. ③After comprehensive measures adopted, upper respiratory tract infection, lower respiratory infection, gastrointestinal infection, urinary tract infection and incision infection were lower than those before comprehensive prevention and control measures adopting, the differences had statistical significance （P 〈 0.05）. Conclusion Elderly, non-preventive use of antibiotics and long duration of operation time, chest drainage time, intubation time, indwelling catheter time are the risk factors of nosocomial infection after cardiac surgery. Com- prehensive prevention and control measures can effectively reduce the incidence of postoperative nosocomial infection.