肺癌压疮患者发生感染危险因素研究及预防对策

Risk factors and preventive measures of infection in lung cancer patients with pressure sore

目的分析肺癌压疮患者发生感染的危险因素,为临床制定有效的预防对策提供参考依据。方法回顾性分析陕西省新安中心医院2018年1月至2020年6月收治的117例肺癌压疮患者的相关临床资料,依据感染情况分为未感染组99例和感染组18例,比较两组患者的基础资料(性别、年龄、体质量指数、皮肤清洁状况、合并糖尿病、压疮分期)、就医情况(就诊季节、住院时间、手卫生、换药、应用抗菌药)以及实验室指标(白细胞计数、血红蛋白水平、白蛋白水平),多因素Logistic回归模型分析肺癌压疮感染患者危险因素。结果117例肺癌压疮患者共235处压疮,18例患者发生感染共计18处,感染率为15.38%(18/117),共培养分离病原菌37株,其中革兰阴性菌16株、革兰阳性菌21株;单因素分析结果显示,年龄≥60岁、体质量指数≥25 kg/m^(2)、皮肤清洁状况差、合并糖尿病、压疮分期Ⅲ~Ⅳ期、春夏季就诊、住院时间>14 d、手卫生不合格、换药不及时、未应用抗菌药、白细胞计数≤6×10^(9)/L、血红蛋白≤60 g/L、白蛋白≤30 g/L的肺癌压疮患者感染率更高(P<0.05);多因素Logistic回归分析结果显示,糖尿病、压疮分期、手卫生、换药、抗菌药、白细胞计数、血红蛋白、白蛋白为肺癌压疮患者发生感染的危险因素(P<0.05)。结论肺癌压疮患者发生感染的危险因素有糖尿病、压疮分期、手卫生、换药、抗菌药、白细胞计数、血红蛋白、白蛋白,临床工作者应针对以上各项危险因素采取有效的预防措施,降低感染率,改善肺癌压疮患者的预后。

Objective To analyze the risk factors of infection in lung cancer patients with pressure sore and provide a reference for clinical formulation of effective preventive measures.Methods A retrospective analysis was conducted on the clinical data of 117 lung cancer patients with pressure sore admitted to Shaanxi Xin’an Central Hospital from January 2018 to June 2020.The patients were divided into uninfected group(99 cases)and infected group(18 cases)according to the infection.The patient’s basic information(gender,age,body mass index,skin cleanliness,combined with diabetes,pressure sore staging)were compared between the two groups,as well as medical treatment(season,hospital stay,hand hygiene,dressing change,application of antibacterial drugs)and laboratory indicators(white blood cell level,hemoglobin level,albumin level).Multivariate logistic regression model was used to analyze the risk factors of lung cancer patients with pressure sore.Results There were 235 pressure sores in the 117 lung cancer patients with pressure sore,and 18 cases of infections occurred in the 18 patients in the infected group.The infection rate was 15.38%(18/117).A total of 37 strains of pathogenic bacteria were isolated and cultured,including 16 strains of Gram-negative bacteria and 21 strains of Gram-positive bacteria.The results of univariate analysis showed that lung cancer patients with pressure sore had a higher infection rate with age≥60 years old,body mass index ≥25 kg/m^(2),poor skin cleanliness,diabetes,stage Ⅲ-Ⅳ pressure sore,spring and summer visits,hospital stay>14 days,unqualified hand hygiene,untimely dressing change,unused antibacterial drugs,WBC count ≤6×10^(9)/L,hemoglobin level≤60 g/L,albumin level≤30 g/L(all P<0.05).Multivariate logistic regression analysis showed that diabetes,pressure sore staging,hand hygiene,dressing change,antibacterial drugs,WBC count,hemoglobin level,and albumin level were risk factors for infection in lung cancer patients with pressure sore.Conclusion The risk factors for infection in lung cancer patients with pressure sore include diabetes,pressure sore staging,hand hygiene,dressing change,antibiotics,WBC count,hemoglobin level,and albumin level.Clinicians should take effective preventive measures against the above risk factors to reduce infection rate and improve the prognosis of lung cancer patients with pressure sore.