CAJ | 학술논문

目的：了解神经外科颅脑手术患者医院感染危险因素，为有效预防医院感染提供依据。方法对2010年1月-2012年12月某院神经外科收治的4246例颅脑手术患者进行调查，分析其医院感染的危险因素。结果4246例颅脑手术患者，术后发生医院感染393例，446例次，医院感染发病率9．26％，例次感染率10．50％；高于同期全院医院感染发病率（2．02％）和例次感染率（3．02％），差异具有统计学意义（χ2值分别为811．06、629．30，P ＜0．001）。感染部位以中枢神经系统（56．50％）为主，其次是呼吸系统（27．36％）。采用非条件单因素 logistic 回归分析，结果显示，性别、年龄、院外感染、原发疾病、手术时间、感染前入住重症监护室（ICU）及天数、手术次数、各侵入性操作以及胃管鼻饲方面，差异有统计学意义（均 P ＜0．05）。将单因素有意义的指标纳入多因素 logistic 回归分析，结果显示，性别、老年患者、患颅脑先天性疾病、入住 ICU 时间＞7 d、使用抗菌药物时间＞7 d、使用中心静脉插管和泌尿道插管以及使用有创呼吸机是神经外科颅脑手术患者医院感染的危险因素。结论神经外科颅脑手术患者医院感染率较高，应加强对其医院感染的监测，同时应针对感染危险因素，采取有效的预防和控制措施，减少医院感染的发生。
목적：료해신경외과로뇌수술환자의원감염위험인소，위유효예방의원감염제공의거。방법대2010년1월-2012년12월모원신경외과수치적4246례로뇌수술환자진행조사，분석기의원감염적위험인소。결과4246례로뇌수술환자，술후발생의원감염393례，446례차，의원감염발병솔9．26％，례차감염솔10．50％；고우동기전원의원감염발병솔（2．02％）화례차감염솔（3．02％），차이구유통계학의의（χ2치분별위811．06、629．30，P ＜0．001）。감염부위이중추신경계통（56．50％）위주，기차시호흡계통（27．36％）。채용비조건단인소 logistic 회귀분석，결과현시，성별、년령、원외감염、원발질병、수술시간、감염전입주중증감호실（ICU）급천수、수술차수、각침입성조작이급위관비사방면，차이유통계학의의（균 P ＜0．05）。장단인소유의의적지표납입다인소 logistic 회귀분석，결과현시，성별、노년환자、환로뇌선천성질병、입주 ICU 시간＞7 d、사용항균약물시간＞7 d、사용중심정맥삽관화비뇨도삽관이급사용유창호흡궤시신경외과로뇌수술환자의원감염적위험인소。결론신경외과로뇌수술환자의원감염솔교고，응가강대기의원감염적감측，동시응침대감염위험인소，채취유효적예방화공제조시，감소의원감염적발생。
Objective To investigate risk factors for healthcare-associated infection(HAI)in patients with craniocerebral operation,and provide reference for the prevention and control of HAI.Methods A total of 4 246 cases of craniocerebral surgery in a neurosurgery department from January 2010 to December 2012 were enrolled in the study,the risk fac-tors for HAI were analyzed.Results Of 4 246 cases of craniocerebral surgery,393 patients developed 446 times of post-operative HAI,HAI incidence rate was 9.26%,case infection rate was 10.50%,which were higher than inci-dence (2.02%)and case infection rate (3.02%)of HAI of all hospital during the same period,the difference was statistically significant (χ2 =811 .06,629.30,respectively,P <0.001).The major infection site was central nervous system (56.50%),followed by respiratory system (27.36%).Unconditional univariate logistic regression analysis showed that sex,age,community-acquired infection,primary disease,operative time,length of stay in intensive care unit (ICU)before infection,the number of surgery,invasive procedures and nasogastric tube,the difference was statistically significant (all P <0.05 ).Multivariate logistic regression analysis showed that sex,elderly pa-tients,congenital brain diseases,stay in ICU>7 d,antimicrobial use >7 d,central venous and urinary tract cathe-terization,invasive ventilator were risk factors for HAI in patients with craniocerebral operation.Conclusion The incidence of HAI in patients with craniocerebral operation is high,effective preventive and control measures accord-ing to risk factors should be strengthened to reduce the incidence of HAI.