胃肠道肿瘤患者术后医院感染危险因素分析

Risk factors for postoperative nosocomial infections in gastrointestinal cancer patients

目的调查胃肠道肿瘤患者术后医院感染情况并分析其危险因素,找出病原菌及导致发生感染的相关因素,并提出相应的预防措施。方法回顾性分析2008年1月-2013年1月胃肠道科收治的268例胃肠道肿瘤手术患者临床资料,所有数据均采用SPSS15.0软件进行统计分析,计数资料采用χ2检验,对危险因素进行非条件logistic回归分析。结果胃肠道肿瘤患者术后医院感染率为33.21%,感染部位以消化道为主,占75.28%;感染病原菌以真菌为主,占42.16%,其次是革兰阴性菌占35.29%,革兰阳性菌占22.55%,经logistic回归分析后结果显示,抗菌药物的使用(β=0.956,OR=5.762)、侵入性操作(β=1.253,OR=7.328)、感染前化疗史(β=1.121,OR=6.563)、重度贫血(β=1.020,OR=6.053)是感染的独立危险因素。结论胃肠道肿瘤患者术后应该合理使用抗菌药物、减少侵入性操作,医护人员应严格执行消毒隔离制度,降低胃肠道肿瘤患者术后医院感染的发生。

OBJECTIVE To investigate the incidence of postoperative nosocomial infections in the gastrointestinal cancer patients. analyze the risk factors. and observe the distribution of pathogens to put forward corresponding prevention measures. METHODS The clinical data of 268 gastrointestinal cancer petients from Jan 2008 to Jan 2013 were retrospectively analyzed. then all the data were statistically analyzed with the SPSS15. 0 software. the chi-square test was conducted for the count data. and the non-conditional logistic regression analysis of the risk factors was performed. RESULTS The incidence of postoperative nosocomial infections was 33.21 % in the gastrointestinal cancer patients. and digestiue gastrointestinal tract infections accounted for 75. 28 %. Among the pathogens causing the infections. the fungi accounted for 42. 16 %. the gram-negative bacteria 35. 29 %, the gram-positive bacteria 22. 55%. The logistic regression analysis indicated that the use of antibiotics （β=0. 956.0R=5. 762）, invasive operation （β= 1. 253. OR = 7. 328）. chemotherapy history before infections （β= 1. 121, OR = 6. 563）, and severe anemia （β= 1. 020. OR = 6. 053） were the independent risk factors for the infections. CONCLUSION It is necessary for the gastrointestinal cancer patients to rea so nab aecept the antibiotics and reduce to bo ted the invasive operation. The medical staff should strictly implement the disinfection and isolation system to reduce the incidence of postoperative nosocomial infections in the gastrointestinal cancer patients.