神经外科颅内肿瘤切除术后患者医院感染危险因素

Risk factors for postoperative healthcareassociated infection in neurosurgical patients undergoing intracranial tumor removal

摘要:

目的探讨神经外科颅内肿瘤切除术患者术后医院感染情况及其危险因素，为制定干预措施提供理论依据。方法采用前瞻性调查方法，监测2013年4月—2014年12月入住某院神经外科并择期进行手术的颅内肿瘤患者术后医院感染发生情况，并采用单因素和多因素logistic回归分析方法进行医院感染危险因素分析。结果共调查1 218例患者，术后发生医院感染163例、193例次，术后医院感染发病率为13.38%、例次发病率为15.85%。医院感染部位主要为颅内（125例，占64.77%），其次为下呼吸道（55例，占28.49%）。多因素logistic回归分析显示手术等级、幕下手术是神经外科颅内肿瘤手术患者术后医院感染的独立危险因素，其OR及95%CI分别为4.352（1.878～10.080）、1.812（1.280～2.564）。结论手术等级高和实施幕下手术的神经外科颅内肿瘤切除术患者术后发生医院感染的风险较高，应针对此类患者采取有效的防控措施，预防医院感染的发生。

Abstract:

ObjectiveTo investigate the occurrence of postoperative healthcareassociated infection(HAI) and its risk factors in neurosurgical patients undergoing removal of intracranial tumor, so as to provide theoretical basis for formulating intervention measures.MethodsProspective survey was adopted to monitor the occurrence of postoperative HAI in patients who admitted to the department of neurosurgery of a hospital and underwent selective removal of intracranial tumor between April 2013 and December 2014 , risk factors for HAI were analyzed with univariate and multivariate logistic regression analysis.ResultsA total of 1 218 patients were surveyed, 163 patents developed 193 times of postoperative HAI, incidence of postoperative HAI was 13.38%, case incidence of HAI was 15.85%. The main HAI site was  intracranial site（n=125，64.77%）, the next was lower respiratory tract （n=55，28.49%）. Multivariate logistic regression analysis showed that operation grade and subtentorial operation were independent risk factors for postoperative HAI in neurosurgical patients undergoing removal of intracranial tumor, OR and 95%CI were 4.352（1.878-10.080）and 1.812（1.280-2.564） respectively. ConclusionRisk of postoperative HAI in neurosurgical patients undergoing high grade operation and subtentorial  removal of intracranial tumor is high, effective prevention and control measures should be taken to prevent the occurrence of HAI.