急诊手术患者发生医院获得性肺炎与呼吸机相关肺炎的危险因素

目的探讨急诊手术患者医院获得性肺炎(HAP)与呼吸机相关肺炎(VAP)的危险因素,为降低医院感染发病率提供依据。方法回顾性调查某院2014年1月—2016年12月急诊手术和择期手术患者的临床资料,分析患者术后HAP与VAP的发病率及其病原菌分布,探究急诊手术患者HAP和VAP的危险因素。结果共选取急诊手术患者3 526例,发生医院感染123例次,医院感染例次发病率为3.49%;急诊手术患者发生HAP、VAP分别为55例次、20例次。共选取择期手术患者6 904例,发生医院感染192例次,医院感染例次发病率为2.78%;择期手术患者发生HAP、VAP分别为53例次、17例次;急诊手术的医院感染例次发病率、HAP和VAP发病率高于择期手术,差异均具有统计学意义(均P0.05)。手术后患者HAP和VAP检出病原菌主要以革兰阴性菌为主。性别(男)、年龄(≥60岁)、昏迷、气管切开/气管插管、机械通气、联合使用抗菌药物、口腔护理、曾入住ICU、手术次数≥2次是急诊手术患者发生HAP的独立危险因素(均P0.05);昏迷、手术次数≥2次是急诊手术患者发生VAP的独立危险因素(均P0.05)。结论急诊手术患者的HAP与VAP的发病率较高,各有相关独立危险因素,应根据相关危险因素采取针对性预防控制措施。

Risk factors for hospital acquired pneumonia and ventilator associated pneumonia in patients undergoing emergency surgery

ObjectiveTo explore risk factors for hospital acquired pneumonia (HAP) and ventilator associated pneumonia (VAP) in patients undergoing emergency surgery, provide evidence for reducing the incidence of healthcare associated infection(HAI).MethodsClinical data of patients undergoing emergency and selective surgery in a hospital from January 2014 to December 2016 were surveyed retrospectively, incidence and distribution of pathogens of HAP and VAP after surgery were analyzed, risk factors for HAP and VAP in patients undergoing emergency surgery were analyzed.ResultsA total of 3 526 patients who underwent emergency surgery were selected, 123 cases of HAI occurred, HAI case rate was 3.49%; 55 cases of HAP and 20 cases of VAP occurred among patients undergoing emergency surgery. 6 904 patients underwent selective surgery, 192 cases of HAI occurred, HAI case rate was 2.78%； 53 cases of HAP and 17 cases of VAP occurred among patients undergoing selective surgery; HAI case rate, incidences of HAP and VAP in the emergency surgery were all higher than those of selective surgery, difference were all statistically significant (all P<0.05). Gram negative bacteria were the main pathogens isolated from patients with HAP and VAP after surgery. Sex (male), age (≥60 years), coma, tracheotomy/tracheal intubation, mechanical ventilation, combined use of antimicrobial agents, oral care, history of staying in ICU, and the number of surgery≥2 times were independent risk factors for HAP in patients undergoing emergency surgery (all P<0.05); coma and the number of surgery≥2 times were independent risk factors for VAP in patients undergoing emergency surgery (both P<0.05).ConclusionIncidences of HAP and VAP are higher in patients undergoing emergency surgery, each has its own independent risk factors, targeted prevention and control measures should be taken according to the relevant risk factors.