气管插管全麻术后医院感染危险因素研究

目的 了解气管全麻术后患者医院感染的发生原因、危险因素及条件。方法 对临床3027例气管全麻术后患者进行了前瞻性和回顾性调查，并对其病原学标本进行常规细菌培养及真菌培养鉴定以及药敏试验。结果 调查3027例患者中共发生医院感染357例，医院感染率为11．79％，尤以肺部感染为主，伤口感染次之；手术时间与手术伤口类型与各部位感染有明显关系；致病菌中以革兰阴性杆菌占主导，为59．61％，革兰阳性球菌明显增多，占35．58％，真菌感染占4．8％，这些菌株对临床常用抗生素都有不同程度耐药性，多重耐药呈增加趋势。结论 发现引起气管全麻患者医院感染的主要危险因素除与宿主对感染的易感染性，包括手术时间、切口类型、原发疾病严重程度和免疫防御功能等有关外，另外医院侵入性操作、抗菌药物使用均与感染发生都有关，明显增加感染的机会，从而针对气管全麻患者医院感染的危险因素，提出了相应预防措施，降低气管全麻患者的感染率。

Risk Factors about Nosocomial Infection in Patients

OBJECTIVE To understand the causes of risk factors about nosocomial infection in patients after general anesthesia with endotracheal intubation.METHODS Retrospective and prospective studies were conducted in 3 027 cases of anesthesia with endotracheal intubation patients during 1998 and 1999.Bacteria and fungi culture and antibiotic sensitivity test were used for pathogen examination.RESULTS Among 3 027 cases,the rate of nosocomial infection was 11.79%,the main pathogens were Gram negative organisms,but the number of Gram positive organisms was increasing (the rates were 59.61% and 35.58%, respectively). The rate of fungus infection was 4.8%,It resisted to antibiotics at different degrees,and many of them showed multi resistant.CONCLUSIONS The results suggest that except the extent of severe disease and immunity,the main risk factors about nosocomial infection be related to medical invasive operation,the operation times,the kind of incision,the severe degree of the primary affection,and the overused antibiotic therapy.Precaution measurements were introduced to lower the infection rate of patients after general anesthesia with endotracheal intubation on the basis of the risk factors submitted in this article.