腹腔镜下胃癌根治术后患者医院感染的危险因素分析与预防对策

Risk factors and preventive measures of nosocomial infections after laparoscopic radical gastrectomy

目的研究腹腔镜下胃癌根治术后患者医院感染的危险因素,并探讨针对性的预防对策。方法选取2015年4月至2018年1月行腹腔镜下胃癌根治术的患者349例,观察并记录患者术后医院感染发生情况,搜集感染患者病原菌标本进行分离鉴定。并统计所有患者性别、年龄、病理类型、胃癌分期、术前住院时间、手术时间、有创性操作、糖尿病史、吸烟史、饮酒史等指标,分析感染发生的危险因素。结果349例患者术后发生医院感染的有40例,感染率为11.5%,以肺部感染为主,22例占55.0%,其次是腹腔感染,12例占30.0%。40例感染患者中共分离培养出47株病原菌,其中革兰阴性菌29株,革兰阳性菌18株,革兰阴性菌中主要是铜绿假单胞菌(15株占31.9%)和肺炎克雷伯菌(9株占19.1%),革兰阳性菌主要是金黄色葡萄球菌(9株占19.1%)和溶血性链球菌(6株占12.8%)。单因素分析显示年龄、胃癌分期、手术时间、糖尿病史、吸烟史等因素是术后医院感染发生的影响因素,差异有统计学意义(χ^2=5.486~10.538,P<0.05);多因素Logistic回归分析显示,患者年龄≥65岁、胃癌分期≥Ⅲ期、手术时间≥3 h、有糖尿病史、有吸烟史是术后医院感染发生的独立危险因素(P<0.05)。结论腹腔镜下胃癌根治术后患者医院感染不容忽视,针对具有相关危险因素的手术患者采用围手术期护理预防措施,能够减少感染发生,促进患者康复。

Objective To study the risk factors of nosocomial infection after laparoscopic radical gastrectomy for gastric cancer in our hospital, and to explore the preventive measures. Methods A total of 349 patients with gastric cancer who underwent laparoscopic radical gastrectomy in our hospital from April 2015 to January 2018 were selected. The incidence of nosocomial infection was observed and recorded. Pathogenic bacteria were collected and identified. The sex, age, pathological type, gastric cancer stage, preoperative hospitalization time, operation time, invasive operation, diabetes history, smoking history, drinking history and other indicators were analyzed to analyze the risk factors of infection. Results There were 40 cases of nosocomial infection after operation in 349 cases, the infection rate was 11.5%, lung infection was the main cause, accounting for 55%, followed by abdominal infection, accounting for 30%.Forty-seven pathogenic bacteria were isolated and cultured from 40 infected patients, among which 29 were Gram-negative bacteria and 18 were Gram-positive bacteria. The main Gram-negative bacteria were Pseudomonas aeruginosa (31.9%) and Klebsiella pneumoniae (19.1%). Gram-positive bacteria were Staphylococcus aureus (19.1%) and Streptococcus hemolyticus (12.8%). Univariate analysis showed that age, gastric cancer stage, operation time, history of diabetes mellitus, smoking history and other factors were the influencing factors of postoperative nosocomial infection, the difference was statistically significant (P<0.05). Multivariate logistic regression analysis showed that age ≥65 years, gastric cancer stage ≥Ⅲ, operation time ≥3 hours, history of diabetes mellitus and smoking were independent risk factors for postoperative nosocomial infection (P<0.05). Conclusions Nosocomial infection in patients after laparoscopic radical gastrectomy could not be ignored. Perioperative nursing and preventive measures can reduce the incidence of infection and promote the recovery of patients.