胆囊切除患者术后医院感染的危险因素分析及预防对策研究

Risk factors and preventive measures of nosocomial infections in patients after cholecystectomy

目的探讨胆囊切除患者术后医院感染的危险因素及有效的预防策略,以降低医院感染率。方法选取医院2015年1月-2016年3月行胆囊切除术的住院患者200例,观察患者的各项自身指标和手术相关指标,统计患者术后医院感染率,并对术后感染患者进行病原学检测,分析导致患者发生医院感染的危险因素并探讨可行的预防措施。结果 200例胆囊切除术患者中13例术后发生感染,感染率6.50%;病原学检测结果显示,在感染患者分泌物中共培养出病原菌46株,其中革兰阳性菌16株,革兰阴性菌27株,真菌3株,分别占34.78%、58.70%及6.52%;患者的年龄、性别等各项自身指标及术中出血量、围术期抗菌药物使用时间等因素与是否发生术后感染无明显相关性,但手术时间>90min、开腹手术、急诊手术、术中进行胆总管探查和发生胆囊破裂为术后感染发生的危险因素;多因素回归分析结果显示,手术时间、手术方式、手术时机及手术中进行胆总管探查和发生胆囊破裂均为患者术后感染发生的独立危险因素。结论胆囊切除患者发生术后感染的因素主要为手术时间过长、开腹手术、急诊手术、术中进行胆总管探查和发生胆囊破裂,患者自身因素对感染的发生影响较小,临床上可在术中针对相关危险因素进行预防,降低医院感染率。

OBJECTIVE To explore the risk factors and effective prevention strategies of nosocomial infections after cholecystectomy,so as to reduce the nosocomial infection rate.METHODS A total of 200 cases of hospitalized patients after cholecystectomy admitted to our hospital from Jan.2015 to Mar.2016 were selected.The patients＇ own indicators and surgery related indicators were observed.The nosocomial infection rate of the patients after operation was statistically studied,and the pathogens were detected in the patients with postoperative infections.The risk factors of nosocomial infections in patients were analyzed,and the feasible preventive measures were explored.RESULTS Among 200 cases of patients after cholecystectomy,13 cases had postoperative infections,with the infection rate of 6.50%.The pathogenic analysis showed that 46 strains of pathogenic bacteria were obtained from the culture of the patients＇ secretions,including 16 strains of gram-positive bacteria,27 strains of gram-negative bacteria,3strains of fungi,accounting for 34.78%,58.70%and 6.52%,respectively.There was no significant correlation between age,genders,other indicators of their own and intraoperative blood loss and perioperative use of antibiotics and postoperative infections.But the operation time more than 90 min,laparotomy,emergency surgery,intraoperative exploration of common bile duct and rupture of the gallbladder were the risk factors of postoperative infections.The multiple regression analysis showed that operation time,operation mode,timing of operation and intraoperative exploration of common bile duct and occurrence of gallbladder rupture were independent risk factors of postoperative infections.CONCLUSIONThe factors that lead to the occurrence of postoperative infection in patients with cholecystectomy were mainly the long operation time,open surgery,emergency surgery,intraoperative exploration of common bile duct and occurrence of gallbladder rupture.The patients own factors have little influence on the infection.Therefore,it is expected to reduce the incidence of nosocomial infection in the patients with prevention of targeted risk factors the operation.