胆囊结石术后发生院内感染的危险因素及护理对策

Infected feature of patients with gallstone surgery and corresponding nursing countermeasure

目的 研究胆囊结石手术后院内感染的发生率以及危险因素,并对护理对策进行探讨,为减少胆囊结石术后院内感染的发生提供理论指导与临床依据。方法 2010年1月-2014年12月在内蒙古医科大学附属医院手术治疗的1200例胆囊结石患者中,共有32例发生了院内感染,将其作为研究对象。分析胆囊结石术后院内感染的发生率、感染部位、病原菌分布以及引发感染的危险因素,并给予相应的护理措施。结果 胆囊结石术后患者发生院内感染率为2.67%,主要感染部位为呼吸道（28.13%）、胆道（21.88%）以及泌尿系统（21.88%）;感染病原菌以革兰阴性菌为主,占54.76%,其中以大肠埃希菌和肺炎克雷伯菌居多,革兰阳性菌占42.86%,以金黄色葡萄球菌和粪肠球菌为主。单因素分析结果显示,年龄、胆囊积液、引流管放置、术中损伤性操作、术后抗菌药物使用时间以及合并基础病均与胆囊结石术后院内感染的发生有关（P〈0.05或P〈0.01）;多因素分析结果显示,年龄≥55岁、术中有损伤性操作、术后抗菌药物使用时间〈7 d以及合并基础病均是胆囊结石术后院内感染的独立危险因素（P〈0.01）。结论 多种因素的共同作用导致了胆囊结石手术患者院内感染的发生,为降低院内感染的发生率,促进术后恢复,医院应采取针对性的护理措施。

Objective To study the infected rate and risk factors on patients with gallstone surgery, the corresponding nursing countermeasure have been investigated, and to provide theoretical guidance and clinical evidence for reducing incidence of nosocomial infection after gallbladder stones. Methods From January 2010 to December 2014, 1200 cases patients with gallstone who were treated by surgery from Affiliated Hospital of Inner Mongolia Medical University were carried out operation, 32 patient with nosocomial infection were chosen as research objects. Their clinical data, the in- cidence of infection, infection site, distribution of pathogens and risk factors caused infection were analyzed, and corre- sponding nursing countermeasures were proposed. Results Gallstone postoperative infection rate was 2.67%, respiratory tract （28.13%）, biliary tract （21.88%） and urinary tract （21.88%） were the main site of infection; the main pathogens was Gram-positive bacteria with 54.76%, Escherichia coli and Klebsiella pneumoniae were majority; 42.86% of pathogens were Gram-positive bacteria, mainly Staphylococcus aureus and Enterococcus faecalis. Results of univariate analysis showed that, aged, gallbladder effusion, drainage tubes placed, intraoperative injury of operation, time of antibiotics use and gallstone with basis disease were related with postoperative nosocomial infection （P 〈 0.05 or P 〈 0.01）; results of multivariate analysis showed that, age 〉 55, intraoperative injury operation and time of antibiotics use postoperatively 〈7 days and consolidated basis disease were independent risk factors for gallstone surgery nosocomial infection （P 〈 0.01）. Conclusion Common variety of factors lead to nosocomial infections on the patients with gallstone surgery. Appropriate measures should be taken, in order to reduce the incidence of nosocomial infections, and promote postoperative recovery.