肝胆系统恶性肿瘤患者术后医院感染及其危险因素

目的了解肝胆恶性肿瘤患者术后医院感染发生情况，探讨术后医院感染的危险因素，为采取有效的预防与控制措施提供依据。方法采用回顾性调查方法，调查2012年1月-2014年12月于某院进行外科手术治疗的肝胆恶性肿瘤患者手术后医院感染发生情况。通过查阅病历收集患者相关资料，分析其术后医院感染的危险因素。结果共调查302例肝胆恶性肿瘤患者，术后发生医院感染42例，感染发病率为13.91%，无多部位感染发生，感染部位以深部手术切口为主（10例，占23.81%），其次为下呼吸道（9例，占21.43%）和消化系统（7例，占16.67%）。42例术后感染患者中，送标本培养38例（占90.48%），共分离病原菌36株，其中革兰阴性菌31株，占86.11%，革兰阳性菌5株，占13.89%。多因素logistic分析显示，手术时间≥2 h（OR=1.48）、超重（或肥胖）（OR=1.40）、术前放射治疗（OR=2.98）是肝胆恶性肿瘤患者术后医院感染发生的独立危险因素（均P<0.05）。结论肝胆恶性肿瘤患者术后医院感染发病率较高，手术时间长、超重（或肥胖）、术前放射治疗是肝胆恶性肿瘤患者术后感染发生的危险因素，应针对其危险因素采取有效的预防控制措施。

Postoperative healthcare associated infection and its risk factors in patients with hepatobiliary malignant tumor

ObjectiveTo investigate the occurrence of postoperative healthcare associated infection(HAI) in patients with hepatobiliary malignant tumor, explore the related risk factors, so as to provide the basis for taking effective prevention and control measures.MethodsThe occurrence of postoperative HAI in patients with hepatobiliary malignant tumor in a hospital from January 2012 to December 2014 were retrospectively analyzed, risk factors for postoperative HAI were analyzed through reviewing and collecting patients’ medical data. ResultsA total of 302 patients were investigated, 42 (13.91%) developed postoperative HAI, no multiple site infection occurred, the main infection site was deep surgical site (n=10, 23.81%）, followed by lower respiratory tract (n=9, 21.43%）and digestive system (n=7, 16.67%). Of 42 infection cases, 38(90.48%）were sent specimens for pathogenic culture, 36 pathogenic strains were isolated, 31 (86.11%) of which were gram negative bacteria, and 5 (13.89%) were gram positive bacteria. Multivariate logistic analysis showed that operation duration≥2 hours (OR=1.48), overweight (or obesity)(OR=1.40), and preoperative radiotherapy (OR=2.98) were independent risk factors for postoperative HAI in patients with hepatobiliary malignant tumor (all P<0.05).ConclusionIncidence of postoperative HAI is high in patients with hepatobiliary malignant tumor, risk factors are long length of operation, overweight (or obesity), and preoperative radiotherapy, effective prevention and control measures against risk factors should be taken.