宫腔镜手术后患者院内感染的相关因素分析

Risk Factors of Nosocomiai Infection in Patients after Hysteroscopy Operation

[目的]分析宫腔镜术后患者发生院内感染的危险因素。[方法]回顾性分析2011年1月至2015年6月在本院行宫腔镜手术治疗的3150例患者术后发生院内感染的情况，单因素筛选与患者术后发生院内感染相关的危险因素，多因素logistic回归分析确定宫腔镜手术后患者院内感染的独立危险因素。[结果]32例患者术后发生院内感染，感染率为1．02％（32／3150），感染类型主要为子宫肌炎（37．50％）、盆腔炎（28．12％），病原菌主要以革兰阳性菌、阴性菌和真菌为主，分别占60．98％、31．71％和7．32％。经单因素分析发现宫腔镜手术后患者发生院内感染的危险因素包括术前炎症、手术时间、住院时间、手术等级、合并慢性疾病、预防应用抗菌药物因素（P〈0．05）；多因素logistic回归分析结果表明术前炎症、手术时间越长、手术等级越高（Ⅳ级）、合并慢性疾病是患者术后发生院内感染的独立危险因素（P〈0．05）。[结论]术前合并炎症、手术时间越长、手术等级越高、合并慢性疾病可增加宫腔镜手术后患者发生院内感染的风险，需采取相应措施以降低术后感染率。

[Objective]To analyze the risk factors of nosocomial infection in patients after hysteroscopy operation.[Methods]Retrospective analysis of 3150 cases of nosocomial infection after surgery in our hospital from January 2011 to June 2015 was conducted, Risk factors associated with nosocomial infection in patients was analyzed by univariate factor screening, Multivariate logistic regression analysis was used to determine the independent risk factors of nosocomial infection in patients after hysteroscopy surgery.[Results]A total of 32 cases with nosocomial infection were observed, yielding a postoperative infection rate of 1.02 % （32/3150）, the main infection types were myositis uterus, pelvic inflammatory disease, which accounting for 37.50% and 28.12%. The main pathogens were Gram--positive and Gram--negative bacteria, fungi each accounting for 60.98%, 31.71%, 7.32%. Univariate analysis showed that preoperative inflammation, operative time, hospital stay, surgical grade, complicated chronic disease, prophylactic use of antimicrobial agents were closely associated with postoperative nosocomial infection （ P 〈0.05）. Furthermore, multivariate logistic regression analysis showed that preoperative inflammation, prolonged operative time, higher surgical grade （Ⅳ grade）, complicated chronic disease were independent risk factors associated with nosocomial infection in patients （ P〈0.05）.[Conclusion]Factors like preoperative complicated inflammation, prolonged operative time, higher surgical grade and complicated chronic disease can increase the risk of nosocomial infection in patients with hysteroscopy. Thus, it needs to take the appropriate measures to reduce postoperative infection rates.