CAJ | 학술논문

目的研究清洁手术术后医院获得性肺炎发生的影响因素,并提出相应的预防控制措施.方法采用流行病学病例-对照研究的方法,回顾性分析2012年1月至2013年9月骨科和胸外科清洁手术术后发生医院获得性肺炎(感染组32例)与未发生(对照组70例)患者在性别、年龄、肺部基础疾病、糖尿病、预防应用抗菌药物、术中追加抗菌药物、应用抑酸剂、术前肺功能/血气、手术时间、手术时长、术后口腔护理等方面的差异.结果在单因素分析中感染组与对照组患者,肺部基础疾病[感染组46.9％(15/32),对照组15.6％ (11/70),x2=11.227,P =0.007]、手术时间≥180 min[感染组62.5％ (20/32),对照组31.4％ (22/70),x2 =8.753,P=0.003]、术后未进行口腔护理[感染组71.9％(23/32),对照组40.6％(28/70),x2 =8.925,P=0.012]方面差异有统计学意义(P＜0.05);在调整了年龄、性别、糖尿病、术前肺功能/血气的影响后,肺部基础疾病[感染组46.9％(15/32),对照组15.6％ (11/70),比值比(OR)=11.953,95％置信区间(CI):8.132 ～ 18.287)、手术时间(≥180 min)[感染组62.5％ (20/32),对照组31.4％ (22/70);OR=3.152,95％CI:1.014 ～7.258]、术中未追加抗菌药物[感染组81.2％ (26/32),对照组59.4％(42/70);OR =9.738,95％CI:3.401 ～ 14.176]、术后未做口腔护理[感染组71.9％(23/32),对照组40.6％(28/70);OR=7.838,95％ CI:2.974 ～ 16.118)]是清洁手术术后发生医院获得性肺炎的独立危险因素.结论入院完善各项检查,及时评估患者肺部基础疾病状态、时间超过3h的大手术在术中追加抗菌药物、术后定期进行口腔护理可以减少清洁手术术后医院获得性肺炎的发生.
목적 연구청길수술술후의원획득성폐염발생적영향인소,병제출상응적예방공제조시.방법 채용류행병학병례-대조연구적방법,회고성분석2012년1월지2013년9월골과화흉외과청길수술술후발생의원획득성폐염(감염조32례)여미발생(대조조70례)환자재성별、년령、폐부기출질병、당뇨병、예방응용항균약물、술중추가항균약물、응용억산제、술전폐공능/혈기、수술시간、수술시장、술후구강호리등방면적차이.결과 재단인소분석중감염조여대조조환자,폐부기출질병[감염조46.9％(15/32),대조조15.6％ (11/70),x2=11.227,P =0.007]、수술시간≥180 min[감염조62.5％ (20/32),대조조31.4％ (22/70),x2 =8.753,P=0.003]、술후미진행구강호리[감염조71.9％(23/32),대조조40.6％(28/70),x2 =8.925,P=0.012]방면차이유통계학의의(P＜0.05);재조정료년령、성별、당뇨병、술전폐공능/혈기적영향후,폐부기출질병[감염조46.9％(15/32),대조조15.6％ (11/70),비치비(OR)=11.953,95％치신구간(CI):8.132 ～ 18.287)、수술시간(≥180 min)[감염조62.5％ (20/32),대조조31.4％ (22/70);OR=3.152,95％CI:1.014 ～7.258]、술중미추가항균약물[감염조81.2％ (26/32),대조조59.4％(42/70);OR =9.738,95％CI:3.401 ～ 14.176]、술후미주구강호리[감염조71.9％(23/32),대조조40.6％(28/70);OR=7.838,95％ CI:2.974 ～ 16.118)]시청길수술술후발생의원획득성폐염적독립위험인소.결론 입원완선각항검사,급시평고환자폐부기출질병상태、시간초과3h적대수술재술중추가항균약물、술후정기진행구강호리가이감소청길수술술후의원획득성폐염적발생.
Objective To study the factors associated with the occurrence of hospital acquired pneumonia after aseptic operation.Methods The study enrolled 32 patients who had hospital-acquired pneumonia(infection group) and 70 patients who did not have hospital-acquired pneumonia(control group)after aseptic operation.Clinical data and metabolic characteristics were analyzed (gender,age,pulmonary underlying disease,diabetes,application of preventive antibiotics,temporarily prescribed antibiotics during operation,application of antacids,preoperative pulmonary function/blood and gas,operation time,length of operation and postoperative oral care).Results In single factor analysis,pulmonary underlying disease[infection group was 46.9％ (15/32),control group was 15.6％,(11/70),x2 =11.227,P =0.007],length of operation (≥ 180 min) [infection group was 62.5％ (20/32),control group was 31.4％ (22/70),x2 =8.753,P =0.041] and absence of postoperative oral care [infection group was 71.9％ (23/32),control group was 40.6％ (28/70),x2 =8.925,P =0.012] showed significant differences between two groups(P ＜ 0.05).After adjusting the effects of age,gender,diabetes and preoperative pulmonary function/blood gas,multinomial logistic regression showed that significant risk factors (P ＜ 0.05) included pulmonary underlying disease[infection group was 46.9％ (15/32),control group was 15.6％ (11/ 70),odds ratio (OR) =11.953,95％ confidence interval(CI):8.132-18.287],absence of temporarily prescribed antibiotics during operation[infection group was 81.2％ (26/32) ; control group was 59.4％ (42/70),OR =9.738,95％ CI:3.401-14.176] and absence of postoperative oral care[infection group was 71.9％ (23/32),control group was 40.6％ (28/70) ; OR =7.838,95 ％ CI:2.974-16.118].These factors were independent risk factors of hospital-acquired pneumoniaafter aseptic operation.Conclusion Examinations,antibiotics and regular oral care can reduce the incidence of hospital-acquired pneumonia after aseptic operation.