世居高原开颅手术后患者医院感染的相关因素分析

Analysis of Related Factors of Nosocomial Infection in Patients after Craniotomy at High Altitude

【目的】分析世居高原患者开颅手术后医院感染的相关因素。【方法】回顾性分析2010年7月至2018年7月本院收治的227例因创伤、肿瘤和其他颅内疾病行开颅手术患者的临床资料,统计患者术后医院感染的发生情况、感染类型及病原菌分布,比较患者一般临床资料,采用Logistic多因素回归分析方法,分析影响患者医院感染的相关因素,并总结其临床预防对策。【结果】227例患者中共有59例于开颅手术后发生医院感染,发生率为25.99%,患者感染部位以肺内为主(45.76%),其次为颅内感染(30.51%)。59例患者共检出病原菌77株,其病原菌以鲍氏不动杆菌为主(44.16%),其次为表皮葡萄球菌(19.48%)。Logistic多因素回归分析显示,年龄>50岁、手术时间≥4h、开放性损伤、拔管时间≥3h是影响世居高原患者开颅手术后医院感染的独立危险因素(P<0.05)。【结论】世居高原患者开颅手术后医院感染的发生率较高且影响因素复杂;重视其高危患者的评估并落实清创、无菌操作、围术期管理,针对性护理等措施,是预防医院感染、提高神经外科手术安全性的关键所在。

[Objective] To analyze the related factors of nosocomial infection after craniotomy in patients living at high altitude.[Methods]The clinical data of 227 patients undergoing craniotomy due to trauma,tumors and other intracranial diseases from July 2010 to July 2018 were retrospectively analyzed.The incidence of nosocomial infection,types of infection and distribution of pathogenic bacteria were analyzed.The general clinical data of patients were compared.Logistic multivariate regression analysis was used to analyze the related factors affecting nosocomial infection of patients.The clinical preventive measures were summarized.[Results]Of the 227 patients,59 had nosocomial infection after craniotomy,the incidence was 25.99%.The main site of infection was in the lungs(45.76%),followed by intracranial infection(30.51%).A total of 77 strains ofpathogenic bacteria were detected in 59 patients.Acinetobacter baumannii was the main pathogen(44.16%),followed by Staphylococcus epidermidis(19.48%).Logistic multivariate regression analysis showed that age>50 years old,operation time(≥4 hours),open injury and extubation time(≥3 hours)were independent risk factors for nosocomial infection after craniotomy in plateau patients(P<0.05).[Conclusion]The incidence of nosocomial infection after craniotomy in patients in plateau area is high and the influencing factors are complex.The key to prevent nosocomial infection and improve the safety of neurosurgery is to pay attention to the evaluation of high-risk patients,implement debridement,aseptic operation,perioperative management and targeted nursing.