神经外科手术患者术后感染的危险因素分析及对策

The analysis about relevant risk factors of postoperative infection in patients of neurosurgery department with surgeries

目的探讨无锡市人民医院神经外科术后感染的危险因素及干预措施，为预防术后感染选取预防性的护理措施提供理论依据。方法采用1∶3配对病例对照研究，选取2015年1月至2016年12月入住神经外科且行手术治疗发生感染的患者为感染组。配对选取性别相同、疾病诊断一致、年龄相差不超过4岁，没有发生感染的患者为对照组，对感染相关危险因素进行分析。结果212例患者中出现术后感染53例，发病率为25.0%（53/212）；以呼吸道感染为主（60.4%，32/53）。感染组患者血糖高、外周血白细胞高、血红蛋白高、术前使用抗生素的情况与对照组比较差异有统计学意义（t/χ2值分别为3.486、2.966、2.196、30.24，P〈0.05）。感染组患者急诊手术，手术持续时间长、术中出血量多，术中输血的情况与对照组比较差异有统计学意义（U/χ2值分别为26.39、2.585、3.409、9.792，P〈0.05）。感染组患者术后使用抗生素种类≥2种、住院天数长的情况与对照组比较差异有统计学意义（U/χ2值分别为85.53、5.810，P〈0.05）。进一步行Logistic回归分析，结果显示术前高血糖、术中出血量、手术持续时间、住院时间是神经外科手术患者术后感染的危险因素。结论神经外科手术患者术后感染的相关危险因素较多，在围手术期给予针对性的干预措施可降低术后感染率。

ObjectiveTo investigate the incidence and risk factors of infection in neurosurgical patients in Wuxi people′s hospital, and to provide reference for the prevention of postoperative infection.MethodsA total of 53 patients with postoperative infection were collected. The design method of one to three matching case-control study was used controlling age, sex and neurosurgical disease. The risk factors of infection were analyzed by retrospective analysis.ResultsAmong 212 patients, 53 developed infections, the incidence rate was 25.0% （53/212） . Respiratory tract infection was the main type of infection （60.4%,32/53）.Patients with high blood glucose, high white blood cells, high hemoglobin, preoperative antibiotics in the infection group （t/χ2=3.486, 2.966, 2.196, 30.24, P〈0.05） . Patients in the infection group had emergency operation, long operation time, intra-operative blood loss, intra-operative blood transfusion （U/χ2=26.39, 2.585, 3.409, 9.792, P〈0.05） . The infection group patients with postoperative use of antibiotics more than 2 kinds, long hospitalization, The difference between the two groups was statistically significant （U/χ2=85.53, 5.810, P〈0.05）. Further Logistic regression analysis showed that preoperative high blood sugar, intraoperative blood loss, operative duration and hospitalization time were the risk factors of nosocomial infection.ConclusionRisk factors for infection in department of neurosurgery are multiple and targeted interventions should be taken to reduce postoperative infection rate.