ICU中心发生胸腔感染的影响因素分析及预防对策

摘要

目的:探讨重症监护病房 (ICU) 中心发生胸腔感染的情况及其影响因素, 并提出相应的预防对策.方法:选择2015年2月至2017年2月我院ICU中心收治的98例患者进行研究, 均为全麻下行开胸术后住ICU者.收集所有患者临床资料, 分析胸腔感染的发生情况, 通过比较发生/未发生胸腔感染患者的临床资料, 探讨ICU中心发生胸腔感染的危险因素, 并提出相应的预防对策.结果:在98例患者中, 有15例发生胸腔感染, 发生率为15.31％, 以铜绿假单胞菌所占比例最高, 为40.00％.单因素分析结果显示:性别、术前抗菌药物的使用、胸管类型和ICU中心胸腔感染无相关性 (P＞0.05), 而年龄、手术时间、术前肺功能、引流管留置时间、手术创口污染、原发病灶蔓延均和ICU中心胸腔感染密切相关 (P＜0.05);多因素logistic回归分析结果显示:年龄≥60岁、手术时间≥2h、术前肺功能、引流管留置时间≥3d、手术创口污染、原发病灶蔓延均是造成ICU中心胸腔感染的独立危险因素 (OR=3.485、3.714、3.571、5.731、6.172、6.081, P＜0.05).结论:ICU中心发生胸腔感染会对患者病情恢复造成较大影响, 在今后临床工作中, 需重视围术期管理, 积极采取合理的预防措施, 降低胸腔感染的发生率.%Objective: To analyze the risk factors of thoracic infection in ICU center and put forward corresponding preventive measures. Methods: 98 cases of patients treated in the ICU center of our hospita from February 2015 to February 2017 were selected as research objects, all the patients were given thoracotomy under general anesthesia. The clinical data were collected, the incidence of thoracic infection and risk factors were analyzed by comparing the clinical data of patients with/without thoracic infection. Results:Among 98 cases of patients, chest infection occurred in 15 cases, the incidence rate was 15.31％, the proportion of Pseudomonas aeruginosa was the highest, which was 40％. Univariate analysis showed that gender, preoperative use of antimicrobial agents, type of thoracic duct had no correlation with the chest infection in ICU center (P＞0.05), but the age, operation time, preoperative pulmonary function, drainage tube indwelling time, surgical wound contamination and primary lesion spreading were closely related to the thoracic infection in ICU Center (P ＜0.05), multivariate logistic regression analysis showed that age ≥60, the operation time ≥2 h, preoperative pulmonary function, drainage tube indwelling time ≥3 d, surgical wound contamination, primary lesion spreading were the independent risk factors for thoracic infection in ICU Center (OR=3.485, 3.714, 3.571, 5.731, 6.172, 6.081, P＜0.05). Conclusion: Thoracic infection in the ICU center had a greater impact on the patients' recovery, more attention should be paid to perioperative management, and reasonable preventive measures should be performed to reduce the incidence of thoracic infection.