神经外科手术患者医院感染及危险因素分析

目的探讨神经外科手术患者发生医院感染的情况及相关危险因素，为预防术后感染提供理论依据。方法回顾性调查某院2 496例神经外科手术患者临床资料，进行单因素和多因素logistic回归分析，分析手术患者发生医院感染的可能危险因素。结果2 496例手术患者发生医院感染421例，447例次，医院感染率为16.87%，例次率为17.91%；医院感染的主要部位为手术部位(42.06%，188例)，其次是下呼吸道(33.56%,150例)和泌尿道(10.51%,47例)等。单因素分析结果显示,年龄、原发疾病、手术持续时间、气管插管/切开、输血、术后二次手术、术前高血糖7项因素是神经外科手术患者医院感染相关危险因素（均P＜0.05）；logistic回归分析结果表明，年龄≥60岁（OR 95% CI：1.19～2.06）、手术时间≥3 h（OR 95% CI：1.61～2.87）、气管插管/切开（OR 95% CI：2.90～5.50）、输血（OR 95% CI：1.58～2.63）及术前高血糖（OR 95% CI：1.52～2.79）是神经外科手术患者医院感染的独立危险因素。结论神经外科手术患者医院感染的发生与多种因素有关，应加强医院感染的监测，重视各环节的质量控制。

Healthcare associated infection and risk factors in patients undergoing neurosurgical operation

ObjectiveTo evaluate the risk factors of healthcare associated infection（HAI） in patients undergoing neurosurgical operation, and provide reference for preventing post operative infection.MethodsClinical data of 2 496 patients undergoing neurosurgical operation were analyzed, univariate analysis and multivariate logistic regression analysis on risk factors for HAI were performed.ResultsOf 2 496 patients, 421 developed 447 episodes of HAI, HAI rate and case rate was 16.87% and 17.91% respectively; the main infection site was surgical site（42.06%，188 cases）,followed by lower respiratory tract（33.56%,150 cases） and urinary tract（10.51%,47 cases）. Univariate analysis showed that the related risk factors for post operative infection were age, primary diseases, duration of operation, tracheal intubation/tracheotomy, blood transfusion, a second operation, preoperative hyperglycemia（all P＜0.05）. Multivariate logistic regression analysis showed that age≥60 years old（OR 95% CI：1.19-2.06）,duration of operation ≥3 hours（OR 95% CI：1.61-2.87）, tracheal intubation/tracheotomy（OR 95% CI：2.90-5.50）, blood transfusion（OR 95% CI：1.58-2.63）, and preoperative hyperglycemia（OR 95% CI：1.52-2.79） were independent risk factors for infection in patients undergoing neurosurgical operation.ConclusionThe occurrence of HAI in patients undergoing neurosurgical operation is related to multiple factors, surveillance on HAI should be intensified.