胸外科医院感染影响因素分析及全程综合护理对预后的影响

Analysis for the influencing factors in department of thoracic surgery and the effects of whole course comprehensive nursing on prognosis

目的分析胸外科感染危险因素,对比全程综合护理和常规护理对预后的影响,提高胸外科院内感染防治和护理水平。方法收集2014年1月至2016年12月胸外科手术患者1 246例,发生院内感染43例,医院感染率3.45%。分析12项胸外科院内感染影响因素,得出胸外科院内感染危险因素;多因素Logistic回归分析得出胸外科院内感染独立危险因素。对比全程综合护理和常规护理对患者预后的影响。结果 12项影响因素中8项为胸外科院内感染危险因素。多因素Logistic回归分析提示,有慢性呼吸系统疾病史、合并细菌感染、感染持续时间≥3 d、呼吸机使用时间≥72 h为胸外科院内感染独立危险因素。1 246例患者中,采用全程综合护理657例,发生医院感染14例,采用常规护理589例,发生医院感染29例,差异有统计学意义(P<0.05)。43例医院感染患者中,采用全程综合护理10例,采用常规护理33例,差异有统计学意义(P<0.05)。结论胸外科院内感染防治应重点关注有慢性呼吸系统疾病史且合并细菌感染的患者,临床治疗中力争将感染持续时间控制在3 d以内,呼吸机使用时间控制在72 h以内。全程综合护理在院内感染发生率方面较常规护理低,能够降低死亡率,减低重度残疾发生率,提高患者治愈率,值得临床推广使用。

Objective To analyze the risk factors of nosocomial infection in department of thoracic surgery,to compare the effects of whole course comprehensive nursing（ WCCN） and routine nursing on prognosis of patients in order to improve the prevention and nursing levels for nosocomial infection in thoracic surgery. Methods A total of 1246 patients who were admitted and treated in department of thoracic surgery of our hospital from January 2014 to December 2016 were enrolled in the study,in whom,there were 43 cases of nosocomial infection,with nosocomial infection rate being 3. 45%. The 12 items influencing factors of nosocomial infection in thoracic surgery were analyzed to find out the risk factors of nosocomial infection.Multivariate Logistic regression analysis was used to analyze the independent risk factors of nosocomial infection in thoracic surgery. The effects of WCCN and routine nursing on the prognosis of patients were compared. Results Among the 12 items influencing factors,8 items were the risk factors of nosocomial infection. Multivariate Logistic regression analysis showed that history of chronic respiratory system disease,bacterial infection,infection duration ≥3d,ventilator use time≥72h were the independent risk factors of nosocomial infection. Among 1246 patients,657 patients were treated by WCCN,in whom 14 patients had nosocomial infection,Among 589 patients who were treated by routine nursing,29 patients had nosocomial infection,the difference was statistically significant（ P 〈0. 05）. Among 43 patients with nosocomial infection,10 patients received WCCN and 33 patients received routine nursing,the difference was statistically significant（ P 〈0. 05）. Conclusion The prevention and treatment of nosocomial infection in thoracic surgery should focus on the patients with chronic respiratory disease history combined with bacterial infection,and in clinical treatment,the duration of infection should be controlled within 3 days,and ventilator use time should be less than 72 hours. The incidence rate of nosocomial infection by WCCN is lower than that of routine nursing,moreover,WCCN can reduce mortality,decrease the incidence of severe disability and improve the cure rate of patients,thus,WCCN is worth using widely in clinical practice.