重度烧伤患者院内感染的发生情况及预防措施研究

赵春月; 张爱茹; 户艳霞

文章摘要

重度烧伤患者院内感染的发生情况及预防措施研究

Incidence and preventive measures of nosocomial infection in patients with severe burn

DOI：10.3969/j.issn.1007-8134.2019.04.009

中文关键词: 重度烧伤院内感染危险因素预防措施

英文关键词: severe burn nosocomial infection risk factors preventive measures

基金项目:

作者	单位
赵春月	北京积水潭医院烧伤ICU
张爱茹	北京积水潭医院烧伤ICU
户艳霞	北京积水潭医院烧伤ICU

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中文摘要:

目的　总结重度烧伤患者院内感染的发生情况，分析发生感染的危险因素。方法　选取2016年4月—2018年9月我院收治的重度烧伤患者86例为研究对象，观察住院期间院内感染发生率，并根据是否发生院内感染分为感染组与非感染组，对比2组患者临床资料，用Logistic回归分析法分析发生感染的危险因素。结果　86例患者院内感染发生率为41.86%，感染部位主要为创面感染，其次是肺部感染和消化系统感染。与非感染组对比，感染组患者存在侵入性操作、手术时间＞3 h、住院时间＞30 d、使用抗生素＞2种、低蛋白血症所占比例及IL-23、IL-18水平显著升高（P均＜0.05）。36例患者分泌物培养出病原菌61株，其中革兰阴性菌32株，以铜绿假单胞菌为主，占24.59%；革兰阳性菌29株，以金黄色葡萄球菌为主，占22.95%。革兰阴性菌中铜绿假单胞菌与肺炎克雷伯菌对氨苄西林、庆大霉素等具有较高的耐药率，对亚胺培南的敏感性较高；革兰阳性菌中金黄色葡萄球菌、溶血葡萄球菌对比呋喃妥因、哌拉西林／舒巴坦、克林霉素的耐药率较高，对万古霉素敏感性较好。感染组患者病死率显著高于非感染组（P＜0.05）。结论　重度烧伤患者院内感染发生率较高，且影响因素较多，在临床治疗及护理过程中应针对相关危险因素制定相应的预防措施，以改善患者预后。

英文摘要:

Objective　To summarize the incidence of nosocomial infection in patients with severe burn, and analyze risk factors of such infection. Methods　From April 2016 to September 2018, 86 patients with severe burn admitted in our hospital were selected as the subjects. The incidence of nosocomial infection in 86 patients during hospitalization was observed, and these patients were divided into infection group and non-infection group according to the presence/absence of nosocomial infection. Clinical data of patients in 2 groups were compared, and risk factors of the infection were analyzed by using Logistic regression analysis. Results　The incidence of nosocomial infection in 86 patients was 41.86%, the main infection site was wound infection, followed by pulmonary infection and digestive system infection. Compared with non-infection group, the percentage of patients in the infection group receiving invasive operations, with operation time＞3 h, hospitalization stay＞30 days, usage of more than 2 types of antibiotics, accompanied with hypoalbuminemia, and levels of IL-23 and IL-18 were significantly increased (P＜0.05). Sixty-one strains of pathogenic bacteria were cultured in the secretions of 36 patients, including 32 strains of Gram-negative bacteria, mainly Pseudomonas aeruginosa (24.59%), 29 strains of Gram-positive bacteria, mainly Staphylococcus aureus (22.95%). Pseudomonas aeruginosa and Klebsiella pneumoniae had a higher resistance to ampicillin and gentamicin and higher sensitivity to imipenem in Gram-negative bacteria. Staphylococcus aureus and Staphylococcus haemolyticus were more resistant and sensitive to vancomycin than furantoin, piperacillin / sulbactam and clindamycin. The mortality of patients in the infection group was significantly higher than that in the non-infection group (P＜0.05). Conclusions　The incidence of nosocomial infection in patients with severe burn is relatively high and influenced by many factors. In the process of clinical treatment and nursing, corresponding preventive measures should be formulated according to the corresponding risk factors, so as to improve the prognosis of patients.

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