胸外科手术后医院获得性肺炎危险因素分析

目的 探讨胸外科手术后患者医院获得性肺炎的危险因素,为制定医院感染控制措施提供理论依据.方法 采用目标性监测的方法对2009年4月-2010年4月胸外科住院手术的312例患者,术后医院获得性肺炎发病率及相关危险因素进行调查分析.结果 312例胸外科手术患者单因素分析,发现长期大量吸烟史、慢性支气管炎肺气肿病史、手术方式、手术时间、气管插管/机械通气、术后切口疼痛明显与术后医院获得性肺炎有显著的关联(P＜0.05),而年龄、住院时间与术后医院获得性肺炎的发生无显著关联；多因素分析筛选出4个术后医院获得性肺炎的相关因素:长期大量吸烟史、慢支肺气肿病史、术后切口疼痛明显、气管插管/机械通气,差异有统计学意义(P＜0.05).结论 长期大量吸烟史、慢支肺气肿病史、术后切口疼痛明显、气管插管/机械通气,是胸外科手术后患者医院获得性肺炎的危险因素；针对危险因素采取有效控制措施,是控制医院获得性肺炎的关键.

Risk factors of hospital-acquired pneumonia after thoracic surgery

OBJECTIVE To study the risk factors of hospital-acquired pneumonia in thoracic surgical patients and provide the theoretical basis for the establishment of hospital infection control measures.METHODS Through target-surveillance,we studied the postsurgical incidence rate and relative risk factors of 312 hospital-acquired pneumonia patients who were hospitalized in the thoracic surgery department from Apr.2009 to Apr.2010.RESULTS Through single factor analysis of the 312 thoracic surgical patients,we found that a long history of heavy smoking,emphysema and chronic bronchitis history,surgical procedure,operation time,trachea intubation/mechanical ventilation,and obviously postoperative incision pain were significantly associated with postsurgical acquired pneumonia(P<0.05),whereas no significant association was found with age,hospitalization time(P>0.05).Multivariate analysis established four factors relevant to postsurgical acquired pneumonia with significant differences(P<0.05):a long history of heavy smoking,emphysema and chronic bronchitis history,obvious postoperative incision pain and trachea intubation/mechanical ventilation.CONCLUSION A long history of heavy smoking,emphysema and chronic bronchitis history,obvious postoperative incision pain and trachea intubation/mechanical ventilation are the main risk factors of hospital acquired pneumonia in thoracic surgical patients.Taking effective control of those risk elements is the key to manage hospital-acquired pneumonia.