脑出血患者手术部位感染目标性监测分析

Objective surveillance of surgical site infections after surgery for intracerebral hemorrhage

目的了解脑出血手术患者的临床特征,为其手术部位感染（SSI）的预防控制提供参考。方法采用前瞻性监测方法收集2014年1-12月在神经外科接受脑出血手术治疗的430例患者临床资料,由专职人员每日填写自定脑出血手术目标性监测登记表,包括患者人口学特征、手术情况及Ⅰ~Ⅲ类SSI感染率等内容,采用EpiData3.1软件对登记表进行录入,采用SPSS 18.0软件进行数据统计分析。结果 430例脑出血手术患者发生SSI15例,感染率为3.49%,其中14例为器官（或腔隙）感染,1例为表浅切口感染;Ⅰ~Ⅲ类切口患者SSI感染率分别为2.62%、9.76%、12.50%,差异有统计学意义（P〈0.05）;急诊手术和择期手术SSI感染率分别为3.97%和1.30%;手术时间〉3h和≤3h患者SSI感染率分别为4.23%和2.90%;SSI共检出病原菌5株,革兰阴性菌和革兰阳性菌分别占60.00%和40.00%。结论脑出血手术SSI以器官（或腔隙）感染为主,感染病原菌以革兰阴性菌为主,SSI的发生受多种因素的影响,应采取综合性的预防控制措施减少SSI的发生。

OBJECTIVE To investigate the clinical characteristics of patients undergoing surgery for intracerebral hemorrhage so as to provide evidence for prevention and control of surgical site infections（SSI）.METHODS The prospective monitoring method was conducted to collect the data of 430 patients undergoing surgery for intracerebral hemorrhage in neurosurgery department from Jan.2014 to Dec.2014.The self-made record form of objective surveillance of the surgery was daily filled by special staff and the form included contents such as demographic characteristics of patients,surgery conditions and SSI rates of typeⅠ-Ⅲincisions.The record form was input into the computer by software EpiData3.1and the statistical analysis was performed by using the software SPSS18.0.RESULTS There were 15 cases of SSI（14organ/lacuna infection and 1superficial infection）among the 430 patients undergoing surgery for intracerebral hemorrhage.The incidence of SSI was 3.49%.The incidences of SSI of type Ⅰ incision,type Ⅱ incision and type Ⅲ incision were 2.62%,9.76% and 12.50%,respectively（P〈0.05）.The incidences of SSI of emergency surgery and selective surgery were 3.97% and 1.30%.The incidences of SSI of patients with surgery duration〉3h and surgery duration≤3hwere 4.23%and 2.90%.Totally 5pathogens were detected including gram negative bacteria（60.00%）and gram positive bacteria（40.00%）.CONCLUSIONSSI of intracerebral hemorrhage is mainly organ/lacuna infection.Gram negative bacteria are common pathogens for the infection.SSI is influenced by various factors.Comprehensive prevention and control measures should be taken to reduce the occurrence of SSI.