外科手术后肺部感染的危险因素分析

目的 分析外科手术后肺部感染的危险因素,为临床术后肺部感染的防控提供参考。方法 随机抽取某三级甲等综合医院2015年1月-2015年12月期间外科手术患者374例为研究对象,将发生术后肺部感染的患者89例设为感染组,未发生术后肺部感染的患者285例设为对照组,回顾性调查两组患者的临床资料并分析引起术后肺部感染的危险因素。结果 单因素分析筛选出外科术后肺部感染相关因素有13个,分别为年龄、基础疾病、颅脑手术、ASA评分、术前住院天数、术前预防使用抗菌药物、手术持续时间、手术性质、NNIS分级、麻醉方式、失血量、输血、入住ICU,进一步多因素logistic回归分析显示,存在基础疾病(P＜0.001,OR=4.038)、全身麻醉(P=0.018,OR=8.292)、NNIS分级≥2(P=0.029,OR=5.013)、ASA评分≥Ⅲ(P=0.005,OR=3.362)、手术持续时间≥3h(P=0.019,OR=3.202)、入住ICU(P＜0.001,OR=11.148)为外科手术后肺部感染的独立危险因素。结论 临床应针对存在基础疾病、全身麻醉、NNIS分级≥2等外科手术后肺部感染的高危因素采取相应的防控措施,以减少术后肺部感染的发生。

Risk factors of pulmonary infection after surgery

Objective To analyze the risk factors of pulmonary infection after surgical operation,and to provide references for the prevention and control of postoperative pulmonary infection. Methods A total of 374 surgical patients were randomly selected as the research object from Jan.to Dec.in 2015 in a tertiary care hospital.89 patients with postoperative pulmonary infection were selected as the infection group,and 285 uninfected were divided into the control group in the corresponding period.A retrospective analysis of the materials obtained from the two groups was made,and the risk factors of postoperative pulmonary infection were investigated. Results The univariate analysis showed that there were 13 related factors of postoperative pulmonary infection,which were the craniocerebral surgery,underlying diseases,preoperative hospital stay,ICU stays,age,surgical duration,surgical nature,anesthesia methods,ASA classification,NNIS grade,blood loss,blood transfusion,preoperative use of prophylactic antibiotics drug.Further multivariate Logistic regression analysis indicated that underlying diseases(P<0.001,OR=4.038),general anesthesia(P=0.018,OR=8.292),NNIS grade more than Ⅲ(P=0.029,OR=5.013),ASA classification more than 2 grade(P=0.005,OR=3.362),surgical duration more than 3h(P=0.019,OR=3.202),ICU stays(P<0.001,OR=11.148)were independent risk factors of postoperative pulmonary infection. Conclusion For these risk factors such as underlying diseases,general anaesthesia,NNIS grade more than 2 and so on,clinical medical staff should take appropriate prevention and control measures to reduce the incidence of postoperative pulmonary infection.