胸外科老年患者围手术期的高危因素分析及护理对策

目的 探讨胸外科老年患者围手术期的高危因素,以提高患者的治疗及护理效果。 方法 分析从2015年5月-2016年5月于湖州市中心医院收治的432例胸外科老年患者的临床资料,依据患者有无出现感染进行分组研究,共36例患者出现感染,纳入感染组;其余在围手术期未出现感染,为非感染组,通过统计学软件SPSS16.0分析感染与患者临床资料的相关性,并制定相关护理对策。 结果 432例胸外科老年患者中出现36例患者感染(8.3%),其余患者在围手术期未出现感染(91.7%)。共感染例次为41例次。其中下呼吸道发生24例,约占感染例次的58.5%,上呼吸道发生5例,约占感染例次的12.2%,表皮切口发生3例,约占感染例次的7.3%,深部切口发生4例,约占感染例次的9.9%,胸膜腔发生3例,约占感染例次的7.3%,泌尿道发生2例,约占感染例次的4.8%。通过单因素分析,本研究发现患者的感染与年龄、是否有吸烟史、住院时间、危险因素评分密切相关(χ2值分别为5.527、8.569、4.159、7.421),差异有统计学意义(均P<0.05);与患者的性别、手术持续时间、失血量无关(均P>0.05)。 结论 年龄、有无吸烟史、住院时间、危险因素评分是胸外科老年患者围手术期的高危易感影响因素,应针对影响因素提供合理的治疗和护理对策。 

Analysis of perioperative high risk factors and nursing countermeasures for elderly patients in thoracic surgery

Objective To explore the risk factors of perioperative period in elderly patients with thoracic surgery and to develop some reasonable care strategies to reduce the risk of postoperative infection. Methods Totally 432 cases of chest surgery in elderly patients with clinical data were analyzed. The 432 patients, which were treated in Huzhou central hospital of Zhejiang from May, 2015 to May, 2016, were divided into two groups, nosocomial infection (36 cases) and uninfected group (396 cases). Statistical analysis runs to analyze the correlation between the patients' infection and clinical data, thus to make corresponding nursing treatment. Results Thirty-six patients (8.3%) out of 432 the elderly patients after thoracic surgery were infected and the rest did not show infection (91.7%). Among them, the lower respiratory tract infection occurred in 24 cases, accounting for about 58.5% of the cases of infection. And 5 cases infections occurred in the upper respiratory tract (12.2%); 3 cases infections occurred in the epidermal incision (7.3%); 4 cases infections occurred in the deep incision (9.9%); 3 cases infections occurred in the pleural cavity (7.3%); 2 cases infections occurred in the urinary tract (4.8%). Through single factor analysis, we found that infection of patients were related with age, smoking history, duration of hospital stay and risk factors score (χ2=5.527, 8.569, 4.159, 7.421, respectively), and the difference was statistically significant (P<0.05); and the statistical analysis showed infections had no correlations with gender, surgery time, blood loss (P>0.05). Conclusion Age, history of smoking, duration of hospital stay and risk factors score were high risk factors for elderly patients of thoracic surgery in the perioperative period. Comprehensive improvement of nursing measures can effectively reduce the incidence of postoperative infection and complications. And it had important guiding significance to the success of surgery.