我院ICU医疗干预措施与医院感染的临床相关性研究

目的探讨重症监护病房（ICU）患者医疗干预措施与医院感染的临床相关性,为医院感染的预防控制和管理提供参考。方法回顾分析2010年1月～2012年1月入住本院重症监护病房≥48 h的实施了医疗干预措施的246例患者的临床资料,记录观察期内对患者实施医疗干预措施的时间,统计医院感染部位及感染菌株种类的构成,对比观察医院感染组及无医院感染组患者的危险因素,分析其医疗干预措施与医院感染的临床相关性。结果246例患者中发生医院感染42例,感染率为17.07%;感染部位以下呼吸道、尿道和颅内感染最多。病原菌医院感染率为76.19%,而实施医疗干预措施发生的病原菌医院感染率占65.62%（χ2=9.980,P〈0.01）。入住ICU时间长、脱水剂应用时间长、机械通气、开放性损伤、合并多发伤、气管切开时间以及不合理应用抗生素是医院感染的危险因素（P均〈0.05）。感染组42例患者的病死率为21.43%,显著高于非感染组的9.31%（χ2=6.334,P〈0.05）。结论重症监护病房患者医院感染发生率较高,感染后可增加患者致残致死率;入住ICU时间、脱水剂应用时间、气管切开时间、机械通气、开放性创伤及合并多发伤、不合理应用抗生素等是医院感染的重要危险因素,临床应针对这些感染因素进行积极预防,在综合考虑患者治疗需要的前提下,应尽量减少过多的医疗干预。

Study on the clinical relevant of the intensive care unit patients with medical interventions and hospital infections

Objective To investigate the clinical relevance of the intensive care unit(ICU) patients with medical interventions and hospital infections,to provide a reference for hospital infection prevention and control management.Methods A retrospective analysis in January 2010 to January 2012 were admitted to intensive care unit for ≥ 48 hours of implementation of the clinical data of 246 cases of patients with medical interventions,the observation period for patients with medical interventions time were recorded,statistic analysis of the site of infection and infection of strains of species composition were done,the hospital infection group and non-hospital infection group of patients with risk factors for infection were contrast observed,clinical relevance of the medical interventions and hospital infection were analyzed.Results Two hundred and forty-six cases of patients with nosocomial infection in 42 cases,the infection rate was 17.07%;the site of infection in the respiratory tract,urinary tract and intracranial infection.Pathogens hospital infection rate was 76.19%,while the implementation of medical interventions occurring pathogens hospital infection rates accounted for 65.62%(χ2=9.980,P <0.01).Admitted to the ICU for a long time,a long time of the application of dehydrating agent,mechanical ventilation,open injury,combined with multiple injuries,tracheostomy time and irrational use of antibiotics were the risk factors for nosocomial infection(P < 0.05).Infection group of 42 cases of patients with a case fatality rate of 21.43%,which was significantly higher than 9.31% of the non-infected group(χ2=6.334,P < 0.05).Conclusion The infection rate of intensive care unit is high,increase in patients with disabling the death rate after infection;ICU stay dehydrating agent application time,tracheotomy time,mechanical ventilation,open wounds and consolidation of multiple injury,unreasonable application antibiotics is an important risk factor of hospital infection,thus,it should actively prevent these infections factors,under the premise of considering the needs of patients,excessive medical intervention should be minimized.