儿童神经外科手术患者医院感染危险因素分析

Analysis of risk factors of nosocomial infection in children with neurosurgery

目的了解儿童专科医院神经外科患者医院感染的发生特点及相关危险因素,为预防术后感染提供理论依据。方法采取前瞻性目标监测,对2014年7月1日-2015年6月30日期间某儿童医院脑外科282例手术患者进行跟踪调查,分析手术患者发生医院感染的主要危险因素。结果 282例手术患者中发生医院感染28例,感染率为9.93%;医院感染29例次,例次感染率为10.28%。感染部位以上呼吸道感染为主(34.48%),其次是手术部位感染(31.03%)和下呼吸道(24.14%)。共监测脑外科手术310台,手术部位感染率为2.90%。儿童神经外科手术患者发生医院感染相关危险因素包括接受手术次数、手术时间、是否植入OMMAYAR囊、术中是否使用显微镜、术中输血史、术中留置导尿、术前预防性用药种类、术后抗生素使用天数和住院天数共9项因素;其中术中留置导尿、术后抗生素使用>7 d和住院天数是主要危险因素(OR=3.53、3.40、1.02,P<0.05)。结论为防控儿童医院神经外科手术患儿术后发生医院感染,重点要关注术中导尿管留置、术后抗生素使用天数和住院时间等重要危险因素,采取综合性预防措施。

Objective To understand the characteristics and related risk factors of nosocomial infections for neurosurgical patients in children＇s special hospital,and to provide theoretical basis for prevention of postoperative infection. Methods A follow-up objective monitoring method was used to investigate the clinical data of 282 patients with brain surgery from July1,2014 to September 30 in 2015. The univariate and multivariate logistic regression analysis were used to analyze the possible risk factors of nosocomial infection within surgical patients. Results There were 28 cases with nosocomial infection in282 cases of surgical patients and the infection rate was 9. 03%. 29 cases were developed,with a rate of 9. 35%. The main hospital infection site was the upper respiratory tract infection（ 34. 48%）,followed by surgical site infection（ 31. 03%）and lower respiratory tract（ 24. 14%）. A total of 310 surgical procedures were monitored and the infection rate was 2. 90%. There were 9 hospital infection-related risk factors in children with neurosurgery patients,including the number of operation,the time of operation,the implantation of OMMAYAR capsule,the use of microscope,intraoperative blood transfusion history,indwelling catheterization,preoperative preventive medication type,postoperative antibiotic use days and the number of days of hospitalization. And the main independent risk factors including intraoperative indwelling catheterization,postoperative antibiotic use 7 d and the number of days of hospitalization（ OR = 3. 53、3. 40、1. 02、P 0. 05）.Conclusion The hospital infection rate is slightly higher within neurological postoperative patients in children＇s special hospital. Hospitalization time,intraoperative catheterization and postoperative antibiotic use days are nosocomial infection risk factors in neurological postoperative patients. Shorten the number of hospital days,the rational use of antibiotics,strict implementation of aseptic operation and taking comprehensive preventive measures should be used to reduce hospital infection incidence.