胸腰段脊柱骨折患者医院感染影响因素分析

Risk factors for nosocomial infection in patients with thoracolumbar fracture

[目的]分析胸腰段脊柱骨折患者发生医院感染的影响因素并提出防治措施。[方法]回顾2010年1月~2015年12月264例胸腰段脊柱骨折患者的临床资料,收集并逐一记录每位患者的性别、年龄、TLICS评分、是否有机械通气和保留导尿等侵入治疗、采取保守或手术治疗方式、是否有复合伤、入住ICU、住院天数、合并甚而基础疾病与卧床时间等临床资料,对其医院感染的影响因素进行分析。[结果]单因素分析结果显示患者年龄大、TLICS评分高、侵入性操作、入住ICU、住院时间(d)、合并基础疾病、卧床时间长(d)和使用糖皮质激素≥3(d)等8个因素均是医院感染的危险因素(P<0.05),手术治疗是医院感染保护性因素(P<0.05);logistic回归分析显示其中年龄(OR1.050,95%C1.006~1.095)、TLICS评分高(OR4.465,95%1.949~10.230)、侵入性操作(OR11.849,95%CI3.302~42.523)和卧床时间(d)(OR1.368,95%CI1.215~1.541)等4个因素是独立危险因素。[结论]胸腰段脊柱骨折患者发生医院感染受多种因素影响,应针对相关危险因素特别是独立危险因素采取防控,增加保护性措施,减少医院感染发生。

[ Objective ] To explore the risk factors for nosocomial infection in patients with thoracolumbar fracture and its preventive measures. IMethod] From January 2010 to December 2015, 264 patients with thoracolumbar fracture were retrospectively analyzed. The relative situations were assessed for exploration of the risk factors of nosocomial infection, including patient＇ s gender, age, TLICS score, compound wounds, ICU stay, hospital stay, comorbidity and in bed time respectively. Furthermore, whether mechanical ventilation or not, whether conservative or surgical treatment were also distinguished. [Result] Univariate analysis showed 8 primary risk factors of hospital infection, including patient older than 60 years, high TLICS score, invasive operation, ICU stay, hospitalization more than 30 days, comorbidities, in bed time more than 10 days, as well as use of glucocorticoid more than or equal to 3 days （P〈O.05） . However, surgical treatment was the protective factor for nosocomial infection （P〈0.05） . In addition, logistic regression analysis showed that age （OR=1.050, 95%CI 1.006-1.095） , TLICS score （OR=4.465, 95% CI 1.949-10.230） , invasive operation （OR=11.849, 95% CI 3.302- 42.523） and in bed time （OR=1.368, 95%CI 1.215-1.541） were the independent risk factors. [Conclusion] Nosocomial infection in thoracolumbar fracture patients has been influenced by many factors. Prevention and control measures should be taken according to the related risk factors, especially independent risk factors.