肝癌介入化疗患者医院感染风险因素分析与防控对策研究

Risk factors for nosocomial iinfections in hepatocellular carcinoma patients undergoing interventional chemotherapy and prevention and control countermeasures

目的回顾性分析肝癌介入化疗患者医院感染风险因素并研究防控对策。方法选取2013年1月-2016年1月942例肝癌介入化疗患者,回顾性调查一般资料、介入手术情况、医院感染、抗菌药物使用时间、住院时间等,引入多因素Logistic回归模型分析肝癌介入化疗者医院感染风险因素,总结防控对策。结果 942例患者,发生医院感染50例,感染率为5.30%;多因素Logistic回归模型分析,年龄>60岁、糖尿病、白细胞计数<2.5×109/L、白蛋白水平≤30g/L、皮肤或黏膜溃损、侵入性操作、介入手术时间>180min、抗菌药物使用时间≥7天、术中出血量≥500ml、伤口疼痛明显和住院时间≥21天是肝癌介入化疗者医院感染的独立风险因素,差异有统计学意义(P<0.05)。结论不断加强肝癌介入化疗者医院感染风险因素回顾性调查,明确风险,早期改进防控对策能最大程度控制医院感染,提升医院感染管理质量。

OBJECTIVE To retrospectively analyze the risk factors for nosocomial infections in hepatocellular carcinoma patients undergoing interventional chemotherapy and put forward the prevention and control countermeasures.METHODS A total of 942 patients with hepatocellular carcinoma who received the interventional chemotherapy from Jan 2013 to Jan 2016 were enrolled in the study.The baseline data,status of interventional surgery,incidence of nosocomial infections,time of use of antibiotics,and length of hospital stay were retrospectively investigated;the multivariate logistic regression model was introduced to analyze the risk factors for the nosocomial infections in the hepatocellular carcinoma patients undergoing interventional chemotherapy,and the prevention and control countermeasures were put forward.RESULTS Of the 942 patients,50had the nosocomial infections,with the infection rate 5.30%.The multivariate logisticregression analysis showed that the independent risk factors for the nosocomial infections in the hepatocellular carcinoma patients undergoing interventional chemotherapy included the more than 60 years of age,diabetic mellitus,white blood cell counts less than 2.5×10～9/L,albumin level no more than 30g/L,skin or mucosal ulceration,invasive operations,time of interventional surgery more than 180 min,time of use of antibiotics no less than 7days,intraoperative bleeding volume no less than 500 ml,obvious wound pain,and length of hospital stay no less than 21 days,there was significant difference（P〈0.05）.CONCLUSIONIt is necessary to consistently strengthen the retrospective survey of the risk factors for the nosocomial infections in the hepatocellular carcinoma patients undergoing interventional chemotherapy,identify the risk factors,and improve the prevention and control countermeasures in early state so as to maximally control the nosocomial infections and raise the quality of management of the nosocomial infections.