耳鼻喉科患者低温等离子术后医院感染分析

Analysis of nosocomial infections after hypothermy plasma operation in patients in ENT department

目的观察耳鼻喉科患者低温等离子术后医院感染的原因、临床表现及影响因素,以利抗菌药物的合理应用。方法选择医院2010年3月-2013年3月耳鼻喉科行低温等离子手术患者1 050例,其中发生医院感染43例,设为感染组,未发生医院感染1 007例,设为对照组,就感染率、感染发生相关原因、主要病原菌及临床表现进行分析,并观察围术期抗菌药物使用情况;数据采用SPSS13.0统计处理。结果 1 050例行低温等离子手术患者中共发生医院感染43例,感染率为4.10%,以手术部位感染最高,占48.84%;其次是呼吸道感染16例占37.22%,消化道感染6例占13.95%;手术时间长、≥2种预防性抗菌药物联用、合并糖尿病、营养状况差、高龄等是易感因素(P<0.05);共培养出病原菌47株,以革兰阳性菌为主27株占57.45%,革兰阴性菌20株占42.55%,前5位病原菌依次是金黄色葡萄球菌、凝固酶阴性葡萄球菌、大肠埃希菌、肺炎克雷伯菌和阴沟肠杆菌,分别占27.66%、23.40%、14.89%、12.77%、8.51%;所有患者均根据近期抗菌谱给予敏感抗菌药物治疗后感染得到控制,无其他相关并发症发生。结论低温等离子术虽然是耳鼻喉科安全微创的手术方式,但如未做好防护,也容易导致医院感染,因此,术前评估,高危患者采取有效干预,手术时间长的患者做好感控预防是降低感染发生率的必要措施。

OBJECTIVE To observe infection causes, clinical manifestations and influence factors of infections after hypothermy plasma operation in patients in the ear-nose-throat （ENT） department in order to facilitate the rational use of antimicrobial agents. METHODS A total of 1050 patients in the ENT department received hypothermy plas- ma operation in Mar. 2010 - Mar. 2013, including 43 cases of nosocomial infections （infection group, and 1007 cases of nosocomial infections （control group）. The infection ineidertce, infection-related causes, main pathogens and clinical manifestations were analyzed and the perioperative use of antibacterial drugs was observed. The data were processed with SPSS 13.0. RESULTS Nosocomial infection occurred in 43 cases of 1050 patients undergoing rou- tine hypothermy plasma operation, the infection rate was 4.10%, with the highest incidence of surgical site infec- tion, accounting for 48. 84%, followed by respiratory tract infection in 16 cases （37.22%）, gastrointestinal infec- tion in 6 cases （13. 95%）. Long operation time, combination with two or more prophylactic antibiotics, accompa- nied diabetes, poor nutritional status, senility were predisposing factors （P〈0. 05）. A total of 47 strains of pathogens were cultured, mainly including 47 strains of gram positive bacteria （57.45 %）, 20 strains of gram neg- ative bacteria （42.55 %）. The top five pathogens were Staphylococcus aureus, coagulase-negative Staphylococci, Escherichia coli , Klebsiella pneumoniae and Enter9bacter cloacae, accounting for 27.66%, 23.40%, 14.89%, 12.77%, and 8.51%. All infections were controlled after patients were given with sensitive antimicrobial treat- ment according to recent antibacterial spectrum, and no other complications occurred. CONCLUSION Although the hypothermy plasma operation is a safe and minimally invasive surgery for ENT, it still easily leads to nosocomial infections if well prevention is not offered. Therefore, preoperative evaluation, effective interventions for high-risk patients, good prevention from infection for patients undergoing long-time surgery are necessary measures to reduce the incidence of infections.