结直肠癌患者腹腔镜术后医院感染的影响因素分析

Influencing factors for postoperative nosocomial infection in colorectal cancer patients undergoing laparoscopic surgery

目的分析结直肠癌患者术后医院感染的影响因素,并针对主要影响因素做出相应预防对策。方法回顾性分析2015年3月-2018年2月医院收治的287例行腹腔镜手术的结直肠癌患者临床资料,分析患者感染部位及病原学特点,单因素以及多因素Logistic分析患者术后发生医院感染的影响因素。结果 287例结直肠癌患者,共有49例发生术后感染,感染率为17.07%;患者主要以呼吸道和消化道感染为主,分别占38.78%、22.45%,共检出病原菌57株,其中革兰阴性菌38株占66.67%,主要为大肠埃希菌和肺炎克雷伯菌;多因素Logistic回归分析结果,吸烟、体质量指数(BMI)、术前未预防使用抗菌药物、糖尿病、手术时间、引流时间是结直肠癌患者术后感染的影响因素(P<0.05)。结论结直肠癌患者行腹腔镜手术后感染风险高,影响感染因素较多,通过采取戒烟、保证足够的营养支持、术前预防使用抗菌药物、缩短手术时间和引流时间等相关措施,有利于减少和预防结直肠癌患者行腹腔镜手术后感染的发生。

OBJECTIVE To investigate the influencing factors for the postoperative nosocomial infection in the patients with colorectal cancer and put forward targeted prevention countermeasures according to the influencing factors.METHODS The clinical data of 287 colorectal cancer patients who underwent the laparoscopic surgery in the hospital from Mar 2015 to Feb 2018 were retrospectively analyzed,the infection sites and etiological characteristics were observed,and the univariate analysis and multivariate logistic analysis were performed for the influencing factors for the postoperative nosocomial infection.RESULTS Of the 287 colorectal cancer patients,49 had postoperative infection,with the infection rate 17.07%,38.78%of whom had respiratory tract infection,and 22.45%had gastrointestinal tract infection.A total of 57 strains of pathogens were isolated,38(66.67%)of which were gram-negative bacteria;Escherichia coli and Klebsiella pneumoniae were the predominant species of the gram-negative bacteria.The result of the multivariate logistic regression analysis showed that the smoking,body mass index(BMI),no preoperative antibiotics prophylaxis,diabetes mellitus,operation duration and drainage time were the influencing factors for the postoperative infection in the colorectal cancer patients(P<0.05).CONCLUSION The colorectal cancer patients are at high risk of infection after the laparoscopic surgery,there are a variety of influencing factors for the infection.It is an effective way to quit smoking,ensure adequate nutritional support,conduct the preoperative antibiotics prophylaxis and shorten the operation duration and drainage time so as to reduce the incidence of postoperative infection in the colorectal cancer patients undergoing the laparoscopic surgery.