围手术期患者发生麻醉相关感染的危险因素及相关预防措施分析

Risk factors for anesthesia-related infections in patients during perioperative period and related prevention measures

目的探讨围手术期患者发生麻醉相关感染的危险因素及相关预防措施,为临床预防提供依据。方法选择2015年1-12月在医院行全麻的手术患者2 624例为研究对象,调查患者的感染率,采用自制的调查问卷对患者的一般资料及临床资料进行记录,分析围术期患者发生麻醉相关感染的危险因素,单因素分析采用χ2检验,多因素分析采用Logistic回归分析。结果 2624例研究对象,发生围术期感染359例,其中呼吸道感染217例,血液感染95例,其他部位感染47例;致病菌分析结果:革兰阴性菌构成比为56.5%,其中不动杆菌比例最高,占17.8%;革兰阳性菌构成比34.3%,其中表皮葡萄球菌比例最高,占10.9%;单因素分析结果显示,未使用过滤器占65.02%,更换钠灰石频率低于1次/天占62.99%、深静脉、动脉穿刺者占32.42%,发生围手术期感染的比例更高,差异有统计学意义(P<0.05)。多因素分析结果显示无使用过滤器、更换钠石灰频率<1次/天、深静脉穿刺是围手术期患者发生麻醉相关感染的独立危险因素。结论影响围术期患者发生麻醉相关感染的高危因素较多,使用过滤器,更换钠石灰频率1次/天,有利于减少围产期麻醉相关感染的发生。

OBJECTIVE To explore the risk factors for anesthesia--related infections in patients during penoperative period and put forward the related prevention measures so as to provide guidance for clinical prevention. METHODS A total of 2 624 who underwent surgeries under general anesthesia from Jan 2015 to Dec 2015 were recruited as the study objects. The infection rate of the patients was investigated, the baseline data and clinical data of the patients were recorded by using self-designed questionnaires, the risk factors for the perioperative anesthesia --related infections were analyzed, the univariate analysis was carried out by using Chi-square test, and the multi- variate analysis was performed with the use of logistic regression analysis. RESULTS Of the 2624 study objects, 359 had perioperative infections, including 217 cases of respiratory tract infections, 95 cases of blood infections, and 47 cases of other sites of infections. Among the isolated pathogens, 56.5% were gram--negative bacteria, and 34.3 % were gram-positive bacteria; Acinetobacter was dominant among the gram--negative bacteria, account- ing for 17.8% Staphylococcus epidermidis was the predominant species of gram--positive bacteria, accounting for 10.9%. The univariate analysis showed that the patients who did not use filters accounted for 65.02%, the patients with the frequency of replacement of sodium lime stone less than 1 time/ day accounted for 62.99% ,the patients with deep vein, artery puncture accounted for 32.42%, and the proportion of the patients with periopera- tive infections was even higher （P〈0.05）. The multivariate analysis indicated that the independent risk {actors for the perioperative anesthesia-related infections included without use of filters, frequency of replacement of sodi- um lime stone less than 1 time/ day, and deep venous puncture. CONCLUSION There are a variety of high-risk factors for the perioperative anesthesia-related infections. The use of filters and frequency of replacement of sodium lime stone 1 time/day may be conducive to the reduction of incidence of the perioperative anesthesia-related infections.