不同手术方式治疗动脉瘤性蛛网膜下腔出血患者医院感染对比分析

Comparative analysis of different surgical modes for treating nosocomial infection in patients with anuerysmal subarachnoid hemorrhage

目的探讨不同手术方式治疗动脉瘤性蛛网膜下腔出血(aSAH)患者的医院感染发生情况,为防控医院感染提供依据。方法选择2014年1月至2018年12月在重庆医科大学附属第二医院接受治疗的aSAH患者143例,其中接受开颅夹闭术治疗的患者99例(开颅夹闭组),接受介入栓塞术治疗的患者44例(介入栓塞组),比较两组患者医院感染发生情况。结果143例患者总体医院感染发生率为23.08%(33/143),医院感染例次率为37.06%(53/143)。其中介入栓塞组患者医院感染发生率为20.45%(9/44),医院感染例次率为25.00%(11/44);开颅夹闭组患者医院感染发生率24.24%(24/99),医院感染例次率为42.42%(42/99)。两组患者医院感染发生率比较差异无统计学意义(χ^(2)=0.25,P>0.05),但两组患者医院感染例次率比较差异有统计学意义(χ^(2)=3.96,P<0.05)。患者总体医院感染部位以下呼吸道为主(52.83%),其次为中枢神经系统(16.98%)。总体医院感染病原菌以革兰阴性菌为主(67.19%),革兰阳性菌占21.88%。两组患者医院感染病原菌组成比较,差异无统计学意义(χ^(2)=1.51,P>0.05)。结论开颅夹闭术和介入栓塞术治疗aSAH患者医院感染发生率均较高,开颅夹闭术医院感染例次率明显高于介入栓塞术,需要针对性做好医院感染防控。

Objective To investigate the occurrence situation of nosocomial infection in the patients with aneurysmal subarachnoid hemorrhage(aSAH)treated by different surgical modes to provide the evidence for the nosocomial infection prevention and control.Methods A total of 143 patients with aSAH in the Second Affiliated Hospital of the Chongqing Medical University from January 2014 to December 2018 were selected,including 99 cases of craniotomy clipping(craniotomy clipping group)and 44 cases of interventional embolization(interventional embolization group).Then the occurrence situation of nosocomial infection was compared between the two groups.Results The overall occurrence rate of nosocomial infections among 143 patients was 23.08%(33/143),and the nosocomial infection case-times rate was 37.06%(53/143).The occurrence rate of nosocomial infection in the patients of the interventional embolization group was 20.45%(9/44),and the nosocomial infection case-times rate was 25.00%(11/44),which in the patients of the craniotomy clipping group were 24.24%(24/99)and 42.42%(42/99)respectvely,and there were no statistical difference in the occurrence rate of nosocomial infection between the two groups(χ^(2)=0.25,P>0.05),but the difference of the nosocomial infection case-times rate between the two groups was statistically significant(χ^(2)=3.96,P<0.05).The overall nosocomial infection site was dominated by lower respiratory tract(52.83%)and followed by central nervous system(16.98%).The pathogenic bacteria of overall nosocomial infections were mainly Gram-negative bacteria(67.19%),and Gram-positive bacteria accounted for 21.88%.The composition of pathogenic bacteria of nosocomial infection had no statistical difference between the two groups(χ^(2)=1.51,P>0.05).Conclusion The occurrence rate of nosocomial infection in the patients with aSAH treated by craniotomy clipping and interventional embolization is relatively high,and the nosocomial infection case-times rate of craniotomy clipping was significantly higher than that of interventional embolization,the prevention and control of nosocomial infection need to be targeted.