标题：全身麻醉手术患者医院感染的危险性因素及预防措施

      作者：冉婷，林小璐，邹香，王惟    重庆市涪陵中心医院麻醉科，重庆 408000

      卷次： 2019年30卷11期

      【摘要】 目的 研究全身麻醉手术患者医院感染的危险性因素及预防措施。方法 回顾性分析2015年12月至2018年1月在重庆市涪陵中心医院行全身麻醉手术的618例患者的临床资料，观察患者术后医院感染状况以及筛查、分析与归纳医院感染的危险因素。结合专业知识，建立多因素Logistic逐步回归模型，对有意义变量进行分析。结果 618例全身麻醉手术患者中医院感染49例，感染率为7.93%，其中569例全身麻醉手术医院未感染者与49例感染者临床及手术资料特征比较差异均无统计学意义(P>0.05)；医院感染者和未感染者的ASA分级>II级构成比(77.55% vs 30.2%)、全凭静脉麻醉构成比(69.39% vs 35.85%)、麻醉通气时间≥2 h构成比(77.55% vs 46.22%)、麻醉机过滤器重复使用构成比(89.80% vs 72.41%)、钠石灰使用<1次/d构成比(51.02% vs 25.66%)、七氟烷使用构成比87.76% vs 68.01%)比较，医院感染者均明显高于医院未感染者，差异均有统计学意义(P<0.05)；建立多因素Logistic回归模型分析，结果显示，ASA分级>Ⅱ级、全麻方式、麻醉通气时间≥2 h、麻醉机过滤器重复使用是全身麻醉手术患者医院感染风险因素(P<0.05)，钠石灰使用是全身麻醉手术患者医院感染保护性因素(P<0.05)。结论 全身麻醉关于手术患者医院感染危险因素多种多样，并非单一因素所致；加强其危险因素监测，针对高危人群进行麻醉风险管理，利于降低医院感染率以及减少抗菌药物使用率。
      【关键词】 全身麻醉；医院感染；危险因素；Logistic；预防
      【中图分类号】 R614.2 【文献标识码】 A 【文章编号】 1003—6350（2019）11—1411—04

Risk factors and preventive measures of nosocomial infection in patients undergoing general anesthesia.
RANTing, LIN Xiao-lu, ZOU Xiang, WANG Wei. Department of Anesthesiology, Fuling Central Hospital of Chongqing,Chongqing 408000, CHINA
【Abstract】 Objective To study the risk factors and preventive measures of nosocomial infection in patients un-dergoing general anesthesia. Methods The clinical data of 618 patients undergoing general anesthesia in Fuling CentralHospital of Chongqing from December 2015 to January 2018 were retrospectively analyzed. The nosocomial infectionstatus and risk factors of nosocomial infection after operation were observed, screened, analyzed and summarized. Com-bined with professional knowledge, a multi-factor Logistic stepwise regression model was established to analyze themeaningful variables. Results Among the 618 patients, 49 had nosocomial infections and the infection rate was 7.93%.There was no significant difference in the characteristics of the clinical and surgical data between 569 patients withoutnosocomial infections (uninfected patients) and 49 patients with nosocomial infections (infected patients), P>0.05. Com-pared with the uninfected patients, the infected patients had higher proportions in ASA classification>level Ⅱ (77.55%vs 30.23%), total intravenous anesthesia (69.39% vs 35.85%), anesthesia ventilation time≥2 h (77.55% vs 46.22%), re-peated use of anesthesia machine filter (89.80% vs 72.41%), sodium lime use <1 time/d (51.02% vs 25.66%), sevofluraneuse (87.76% vs 68.01% ), with statistically significant difference (P<0.05). Multivariate logistic regression analysisshowed that the risk factors of nosocomial infection in patients undergoing general anesthesia were ASA grade>Ⅱ grade,general anesthesia mode, anesthesia ventilation time≥2 h, and repeated use of anesthesia machine filters (P<0.05), andthe use of sodium lime was the protective factor for nosocomial infection in patients undergoing general anesthesia (P<0.05). Conclusion The risk factors of nosocomial infection in patients undergoing general anesthesia are varied and notcaused by a single factor. The monitoring of risk factors and the management of anesthesia risk for high-risk groups areconducive to reducing the rate of nosocomial infection and reducing the use of antimicrobial agents.
      【Key words】 General anesthesia; Nosocomial infection; Risk factors; Logistic; Prevention