腺样体肥大患者围手术期医院感染病原学特点及影响因素分析

Etiological characteristics and influencing factors for perioperative nosocomial infections in patients with adenoidal hypertrophy

目的分析腺样体肥大患者围手术期医院感染的发病特点及引起感染的危险因素。方法选择2016年6-12月于医院进行手术的182例腺样体肥大患者为研究对象,分析患者发生医院感染及病原菌检出情况和导致医院感染的影响因素。结果 182例患者围手术期共发生医院感染41例次,例次感染率为22.53%;主要感染部位为呼吸道和手术部位感染;临床送检标本共分离病原菌41株,其中革兰阴性菌15株占36.59%,革兰阳性菌16株占39.02%,真菌10株占24.39%;单因素分析结果显示,病程、手术时间、住院时间、SAS评分及合并Ⅳ度阻塞、哮喘史、糖尿病史、留置尿管与发生感染相关(P<0.05);多因素结果显示,病程、手术时间、住院时间、SAS评分及合并Ⅳ度阻塞、哮喘史、糖尿病史、留置尿管是发生感染的独立影响因素(P<0.05)。结论腺样体肥大患者围手术期医院感染的发生率较高,较长病程、手术时间、住院时间、高SAS评分及合并Ⅳ度阻塞、糖尿病史、哮喘史、留置尿管是发生医院感染的影响因素,应加以重视和预防。

OBJECTIVE To investigate the etiological characteristics of perioperative nosocomial infections in pa- tients with adenoidal hypertrophy and analyze the influencing factors for the infections.METHODS A total of 182 patients with adenoidal hypertrophy who received surgical procedures in the hospital from Jun 2016 to Dec 2016 were recruited as the study objects.The incidence of nosocomial infections, distribution of isolated pathogens and influencing factors for nosocomial infections were observed.RESULTS Among the 182 patients, 41 case-times of pa- tients had nosocomial infections during perioperative period, with the case-time infection rate 22.53%. The respiratory tract and surgical site were the major infection sites.Totally 41 strains of pathogens were isolated from submitted clinical specimens, of which 15 （36.59%） were gram-negative bacteria, 16 （39.02%） were gram-positive bacteria, and 10 （24.39 % ） were fungi.The result of univariate analysis showed that the incidence of the infections was associated with the disease course, operation duration, length of hospital stay, SAS score, complication with grade IV obstruction, asthma history, diabetes mellitus history and catheter indwelling （P〈0.05）. The multivariate analysis indicated that the inde- pendent influencing factors for the infections included the disease course, operation duration, length of hospital stay, SAS score, complication with grade IV obstruction, asthma history, diabetes mellitus history and catheter indwelling （P〈0.05）.CONCLUSION The incidence rate of perioperative nosocomial infections is high in the patients with adenoidal hypertrophy.The influencing factors for the nosocomial infections include the long disease course, operation dura- tion, length of hospital stay, high SAS score, complication with grade IV obstruction, asthma history, diabetes mellitus history and catheter indwelling, and it is necessary to pay attention to the prevention.