颈椎脱位伴颈髓损伤术后患者医院感染的危险因素与预防

Risk factors for postoperative nosocomial infections in cervical dislocation patients complicated with cervical spinal cord injury and prevention measures

目的探讨颈椎脱位伴颈髓损伤术后患者医院感染的危险因素,并制定针对性干预对策,减少该类感染发生。方法分析2012年3月-2015年9月医院收治的104例颈椎脱位伴颈髓损伤手术患者的临床资料,对患者切口分泌物进行细菌学培养,采用SPSS 21.0软件分析患者医院感染的危险因素。结果 51例患者发生医院感染,感染率49.04%,经细菌培养共分离75株病原菌,其中革兰阴性菌47株占62.67%,以大肠埃希菌为主占34.67%,其次为铜绿假单胞菌占20.00%,革兰阳性菌25株占33.33%,以金黄色葡萄球菌为主占22.66%,真菌3株占4.00%;多因素logistic回归分析显示,侵入性操作、GCS评分、昏迷、APACHEⅡ评分、激素应用时间是患者发生医院感染的独立危险因素(OR=4.271、-3.185、3.072、2.389、4.093、2.014,P<0.05)。结论颈椎脱位伴颈髓损伤患者术后医院感染的独立危险因素多,临床应采取针对性的措施予以干预。

OBJECTIVE To explore the risk factors for the postoperative nosocomial infections in the cervical dislocation patients complicated with cervical spinal cord injury and put forward the targeted intervention countermeasures so as to reduce the incidence of the infections.METHODS A total of 104 cervical dislocation patients complicated with cervical spinal cord injury who were treated in the hospital from Mar 2012 to Sep 2015 were enrolled in the study,the clinical data of the enrolled patients were analyzed,the incision secretions specimens were collected for the bacteriological culture,and the statistical analysis of the risk factors for the nosocomial infections was performed with the use of SPSS 21.0software.RESULTS The nosocomial infections occurred in 51 patients,with the infection rate of 49.04%.Totally 75 strains of pathogens were isolated through the bacterial culture,including 47（62.67%）strains of gram-negative bacteria,25（33.33%）strains of gram-positive bacteria,and 3（4.00%）strains of fungi;the Escherichia coli was the predominant species of gram-negative bacteria,followed by the Pseudomonas aeruginosa（20.00%）;the Staphylococcus aureus（22.66%）was dominant among the gram-positive bacteria.The multivariate logistic regression analysis indicated that the independent risk factors for the nosocomial infections included the invasive operation,GCS score,coma,APACHEⅡ score,and time of use of hormone（OR=4.271,-3.185,3.072,2.389,4.093,2.014,P〈0.05）.CONCLUSIONThere are a variety of independent risk factors for the postoperative nosocomial infections in the cervical dislocation patients complicated with cervical spinal cord injury,and it is necessary for the hospital to take the targeted intervention measures.