耳鼻喉科患者手术后医院感染相关因素分析

Risk factors for postoperative nosocomial infections in the department of otorhinolaryngology

目的探讨耳鼻喉科患者手术后发生医院感染的相关因素,为提高耳鼻喉科患者生命质量提供参考。方法对2011年1月-2016年12月于耳鼻喉科进行手术患者的临床资料进行统计,分析耳鼻喉科手术患者发生医院感染的易感因素,采用列联表卡方检验和多因素logistic回归进行分析。结果在6 753例耳鼻喉科手术患者中,152例(2.25%)发生医院感染。单因素分析显示,性别、年龄、住院时间、是否转科、切口类型、手术时长、合并症与耳鼻喉科患者手术后发生医院感染有关。未发生医院感染的耳鼻喉科手术患者的疾病治愈率高于发生医院感染的患者(P<0.05);logistic多因素回归分析结果显示,男性(OR=2.831,95%CI:1.758~4.558)、年龄较大(OR=5.833,95%CI:4.491~7.577)、转科(OR=1.790,95%CI:1.008~3.178)、切口污染等级较高(Ⅰ类切口、Ⅱ类切口、Ⅲ类切口的OR值分别为34.866、2 120.995、43 917.453)和手术时间较长(OR=9.384,95%CI:18.168~47.525)为耳鼻喉科手术患者发生医院感染的独立危险因素。结论耳鼻喉科手术患者发生医院感染是多因素共同参与的结果,要从患者的实际身体状况出发,进行全面综合的医院感染防治。

Objective To analyze the risk factors for postoperative nosocomial infections in the department of otorhinolaryngology, and provide guidance on improving the quality of life for patients. Methods The clinical data of the patients undergoing surgical procedure in the department of otorhinolaryngology form January 2011 to December 2016 were reviewed to identify the potential risk factors of nosocomial infections. Chi-square test and multivariate logistic regression model were used for the analysis. Results A total of 152（2.25%） cases of nosocomial infection were identified in 6 753 cases of surgical operation. Univariate analysis revealed that sex, age, length of stay, patient referral, class of surgical wounds, length of operation, and complications were related to postoperative nosocomial infections. The patients without nosocomial infection showed higher cure rate than those complicated with nosocomial infection（P〈0.05）. Multivariate logistic regression analysis identified that male（OR=2.831, 95% CI： 1.758-4.558）, older（OR=5.833, 95% CI： 4.491-7.577）, patient referral（OR=1.790, 95% CI： 1.008-3.178）, higher class of surgical wound contamination（OR=34.866 for Class I, OR=2 120.995 for Class II, and OR=43 917.453 for Class III wounds）, and longer length of operation（OR=9.384, 95% CI： 18.168-47.525） were the independent risk factors for postoperative nosocomial infections in the department of otorhinolaryngology. Conclusions Multiple risk factors are associated with postoperative nosocomial infections in the department of otorhinolaryngology. Integrated measures must be taken for prevention and control of nosocomial infections based on the specific conditions of the patient.