胸腔闭式引流术后发生胸腔感染的危险因素调查及预防

Risk factors for postoperative thoracic cavity infections in patients undergoing chest closed drainage and prevention measures

目的调查胸腔闭式引流术后发生胸腔感染的危险因素,提出预防对策,为预防胸腔感染发生提供参考。方法收集2010年1月-2015年8月医院行胸腔闭式引流术的528例患者临床资料,调查分析可能引起胸腔感染发生的危险因素;采用SPSS17.0软件进行数据统计分析。结果 528例患者术后发生胸腔感染42例,感染率7.95%;单因素分析显示,年龄≥60岁、有糖尿病、有低蛋白血症、有慢性阻塞性肺疾病、术前肺功能异常、出现过引流瓶高于胸腔、引流管留置时间>3d、围术期抗菌药物应用时间>3d、引流操作医师年资≤10年等为行胸腔闭式引流术患者发生胸腔感染的相关因素(P<0.05);Logistic回归分析显示,合并糖尿病、合并低蛋白血症、合并慢性阻塞性肺疾病、术前肺功能异常、引流瓶高于胸腔、引流管留置时间过长是患者术后发生胸腔感染的独立危险因素,差异有统计学意义(P<0.05)。结论引起胸腔闭式引流术后发生胸腔感染的危险因素较多,积极治疗糖尿病及低蛋白血症等合并症、缩短引流时间、防止引流瓶位置过高是预防胸腔感染发生的主要措施。

OBJECTIVE To investigate the risk factors for postoperative thoracic cavity infections in patients undergoing chest closed drainage and put forward the prevention countermeasures so as to logisticprovide guidance for prevention of the thoracic cavity infections.METHODS The clinical data wee collected from 528 patients who underwent the chest closed drainage from Jan 2010 to Aug 2015 and then were investigated,the risk factors for the thoracic cavity infections were observed,and the statistical analysis of data was performed with the use of SPSS17.0software.RESULTS Of the 528 patients,42had the postoperative thoracic cavity infections,with the infection rate 7.95%.The related factors for the thoracic cavity infections in the patients undergoing the chest closed drainage included the no less than 60 years of age,diabetic mellitus,hypoproteinemia,chronic obstructive pulmonary disease,preoperative abnormal pulmonary function,drainage bottle higher than thoracic cavity,time of drainage tube indwelling more than 3days,and no more than 10 years of experience for drainage operation（P〈0.05）.The logisticregression analysis indicated that the independent risk factors for the postoperative thoracic cavity infections included the complication of diabetic mellitus,complication of hypoproteinemia,complication of chronic obstructive pulmonary disease,drainage tube higher than thoracic cavity,and prolonged drainage tube indwelling（P〈0.05）.CONCLUSION There are a variety of risk factors for the postoperative thoracic cavity infections in the patients undergoing the chest closed drainage.It is an effective way to actively treat the complications such as diabetic mellitus and hypoproteinemia,shorten the drainage time,and prevent the high position of the drainage bottle so as to prevent the thoracic cavity infections.