高血压脑出血手术患者医院感染现状及危险因素分析

Health economic evaluation related to nosocomial infection of patients with surgery of hypertensive intracerebral hemorrhage

目的分析高血压脑出血手术患者医院感染现状及感染相关因素,发现导致医院感染发生的关键因素及环节,为改进临床诊疗、护理工作提供依据。方法回顾性研究某三级甲等医院2015—2016年两年间由神经外科病区出院的高血压脑出血手术患者,包括性别、年龄、意识状况、住院天数、尿管留置时间以及侵入性操作等。数据用均数±标准差、率、百分比表示,计数资料间比较采用χ~2检验,多因素分析采用logistic回归。结果 2015—2016年两年间高血压脑出血手术患者医院感染发生率为20. 96%,感染例次发生率为25. 37%;高血压脑出血手术患者医院感染部位以下呼吸道为主,占59. 42%; 36例感染患者进行了细菌培养,共检出菌株43株,革兰氏阴性菌共32株,以鲍曼不动杆菌为主;革兰氏阳性菌株6株,最常见的是金黄色葡萄球菌。"是否入住ICU"及"入住ICU的天数"为患者发生医院感染的独立危险因素。结论高血压脑出血手术患者医院感染发生率高于神经外科其他病种,"是否曾入住ICU"及"入住ICU的天数"是高血压脑出血手术患者发生医院感染的独立危险因素,应针对危险因素采取防控措施,缩短患者入住ICU的时间,降低医院感染率。

Objective To investigate the prevalence of nosocomial infection in hypertensive intracerebral hemorrhage patients by analyzing retrospective investigation of nosocomial infection in 272 patients with neurosurgical hypertensive intracerebral hemorrhage in a III-A general hospital,and to analyze the related factors of nosocomial infection and find out the infection key factors and links,in order to improve the clinical diagnosis,treatment and nursing work.Methods Totally 272 patients with hypertensive intracerebral hemorrhage were selectedina III-A hospital from January 1,2015 to December 31,2016.A retrospective survey of hospital infection in all patients with hypertensive intracerebral hemorrhage.The survey included gender,age,awareness status,presence or absence of other diseases,length of hospital stay,catheter retention time,and invasive operation and so on.The data were measured by the standard deviation,the rate and the percentage.The χ^2 test was used to compare the count data.The T test and the rank sum test were used to measure the data.Multivariate analysis was logistic regression and P <0.05 was taken as statistically significant.Results A total of 272 patients underwent hypertensive intracerebral hemorrhage surgery,57 patients with nosocomial infection,and the incidence of infection was 20.96%.Infection occurred in 69 cases,with the incidence 25.37%.Between 2015 and 2016,the incidence of nosocomial infection was declining. Lower respiratorytract ranked first in the parts of patients with hypertensive intracerebral hemorrhage,accounting for 59.42%.Bacterial culture was carried out for 36 infected patients and 43 strains were detected including 32 strains of Gram-negative bacteria,mainly Acinetobacter baumannii;6 strains of Gram-positive strains,of which the most common was Staphylococcus aureus.Whether the ICU stay and the number of ICU stay days in the hospital were the independent risk factorsof hospital infection.Conclusion The incidence of nosocomial infection of patients with hypertensive intracerebral hemorrhage is higher than that of the general nosocomial infection in the same period.Theadmission to ICU,and the hospitalization days in ICU,is an independent risk factor for nosocomial infection in patients with hypertensive intracerebral hemorrhage.Control measures should be taken to prevent these risk factors,to shorten the time of stay in ICU,and to reduce the hospital infection rate.Hospital infection resulted in an increase in hospitalization costs and prolonged hospitalization.Increased hospitalization costs and prolonged hospitalization days were different at the sites of infection and the patients’age.