神经外科手术患者医院感染的危险因素分析

目的分析神经外科患者手术后医院感染的危险因素,探讨预防控制神经外科医院感染的对策。方法回顾性分析2010-01—2012-01收治的441例神经外科患者的资料,按照是否合并医院感染,对医院感染发生率及危险因素进行分析。结果 441例患者中发生医院感染14例,感染率3.2%;其中年龄≥60岁感染率9.12%,急诊手术感染率6.8%,手术时间≥3h,术前存在感染灶感染率为25%,经卡方检验,差异均有统计学意义(P<0.05)。结论神经外科患者手术后合并医院感染与以上各种危险因素有关,应加强术前、术中、术后质量管理,尽量缩短手术时间,加强手术前病灶的管理以降低神经外科手术患者医院感染发生率。     

神经外科住院患者医院感染危险因素分析

本对476例神经外科住院患进行感染因素的调查．结果如下。     

神经外科病人医院感染相关因素分析及护理对策

目的 了解神经外科病人医院感染发生率及危险因素,探讨护理对策.方法 回顾性调查2006-10～2008-12收治的490例神经外科患者发生医院感染的部位、原因、病原菌.结果 发生医院感染52例(10.61%); 致感染的病原菌主要是金黄色葡萄球菌、铜绿假单胞菌、克雷伯氏菌、大肠埃希菌;感染主要为下呼吸道(55.07%)、泌尿道(15.94%)、手术切口(10.14%)、 胃肠道(8.67%)等;感染的相关因素有:意识障碍、脑外伤或脑卒中、侵入性操作等.结论 针对各种危险因素对医院感染进行监测,做好留置管道的护理工作,加强基础护理,合理使用抗生素,做好病室的清洁消毒工作.     

神经外科重症监护患者肺部感染的相关危险因素分析及护理对策

目的：分析神经外科重症监护患者肺部感染的相关危险因素,并探讨相应的护理对策。方法将2012‐01‐12神经外科78例重症监护患者为研究对象,统计肺部感染发生率,分析引起肺部感染的相关危险因素,并在2013‐01以后的临床护理工作中实施相应的护理对策。对比2012年和2013年患者肺部感染发生率和护患满意率的差异性。结果与2012年对比,2013年神经外科重症监护患者肺部感染发生率明显降低,护患满意率明显升高,差异有统计学意义（ P＜0.05）。结论气管切开、大剂量使用激素、吸烟史、合并肺部原发病是引起神经外科重症监护患者肺部感染的主要危险因素,在护理工作中加强呼吸道管理有助于控制感染。     

神经外科手术患者医院感染分析

目的探讨神经外科手术患者医院感染发生特点和相关危险因素,为预防与控制医院感染提供参考。方法对我院神经外科2009-01—2011-12收治的505例颅脑手术患者的临床资料进行分析。结果 505例手术患者中发生医院感染81例,感染率为16.04%,医院感染90例次,例次感染率17.82%;以呼吸道感染最多,占56.67%,其次为手术部位感染,占23.33%;有侵入性操作患者医院感染发生率20.58%,术者为副主任医师及以上者手术部位感染率3.68%,其他职称者18.75%。结论侵入性操作、手术医生的手术技巧及无菌观念与神经外科手术患者医院感染的发生相关,需采取综合干预措施降低医院感染发病率。     

神经外科患者肺部感染发生因素与护理体会

目的探讨神经外科患者合并肺部感染患者的相关因素,并总结有效的护理措施。方法以我院神经外科住院部于2014-01—12收治的100例合并肺部感染患者为观察对象,对其发生肺部感染的因素进行分析,随机分为对照组与观察组各50例,对照组给予常规护理,观察组在常规护理的基础上针对患者的风险因素给予相应的护理措施,对比2组治疗效果。结果本组误吸、气道湿化不足、口咽部定植细菌下行、年龄过大及住院时间过长等是患者发生肺部感染发生的主要因素,分别占29%、20%、16%、16%、11%及8%。本组所有患者肺部感染均得到有效控制,观察组中痊愈13例,显效22例,有效11例,无效4例,总有效率92%(46/50),明显高于对照组(P0.05)。结论误吸、气道湿化不足、口咽部定植细菌下行等是神经外科患者全部肺部感染的重要风险因素,在护理中根据不同的发病原因给予相应的护理措施可有效改善感染状况,提高治疗效果。     

神经外科医院感染特点及易感因素分析

目的了解神经外科的医院感染特点,并探讨神经外科患者医院感染的易感因素,以控制和减少医院感染率。方法采取目标监测及回顾性调查的方法,对2010—2011年入住神经外科的1 844例患者的临床资料进行统计。结果 1844例住院患者中查出188例医院感染,神经外科医院感染率10.19%,显著高出同期的医院平均感染率4.7%,感染205例,发病率11.11%,同样高于同期医院平均感染例次发病率5.2%;感染部位的构成比以下呼吸道最高,为43.16%,其次为泌尿系统(18.96%)和消化系统(13.69%);神经外科病房医院感染的发生与患者年龄、住院时间、昏迷、手术时间长和侵入性操作等因素有关。结论神经外科医院感染率明显高于其他科室,需采取综合性的防范措施才能有效降低医院感染发病率。     

神经外科病人血流感染危险因素分析

目的 探讨神经外科病人发生血流感染的危险因素。方法 回顾性分析2014年6月至2018年1月神经外科收治的1 573例病人的临床资料,采用多因素Logistic回归分析检验危险因素。结果 1 573例中,发生血流感染126例,感染率为8.01%。126例血培养标本检出142株致病菌,其中革兰阳性菌68株（47.89%）,革兰阴性菌72株（50.70%）,真菌2株（1.41%）。多因素Logistic分析显示,深静脉置管、气管切开机械通气、留置导尿、使用糖皮质激素、血清降钙素原>0.5 ng/ml、血溏>11.1 mmol/L是神经外科病人发生血流感染的独立危险因素（P<0.05）。结论 做好评估,减少不必要的侵入性诊疗;合理使用糖皮质激素,控制血糖;监测降钙素原早期预测与干预可能是减少神经外科血流感染的有效措施。     

1757例神经外科住院患者医院感染分析

对我院2002年1月-2003年12月神经外科出院患进行回顾性调查分析，旨在找出主要感染原因，并进行预防和控制。     

神经外科医院感染的特点及病原菌耐药性分析

目的分析神经外科病房医院感染的特点及细菌耐药动态，为神经外科患者医院内感染的预防和治疗提供依据。方法回顾性分析2006年1月至2007年12月我院神经外科收治患者的临床资料，对其中发生医院感染病例的细菌种类、感染部位、耐药率等进行重点分析。结果神经外科的医院感染例次率是15.3％，明显高于全院同期发生感染的例次率（3．6％）（P〈0.05）；病原菌以G^-杆菌为主（59．8％），G^＋球菌为32．5％，真菌为7．6％；以下呼吸道感染居多（63．8％），其次为泌尿道感染（15．5％）和血液系统感染（8．2％）等。结论系统监测神经外科医院感染的特点及其细菌耐药动态，对临床合理使用抗生素具有重要的参考价值：降低神经外科医院感染率的重点是控制下呼吸道感染，其他综合性治疗措施也应予以重视。     

Incidence and Risk Factors of Acute Postoperative Delirium in Geriatric Neurosurgical Patients

Objective

Postoperative delirium (POD) is characterized by an acute change in cognitive function and can result in longer hospital stays, higher morbidity rates, and more frequent discharges to long-term care facilities. In this study, we investigated the incidence and risk factors of POD in 224 patients older than 70 years of age, who had undergone a neurosurgical operation in the last two years.

Methods

Data related to preoperative factors (male gender, >70 years, previous dementia or delirium, alcohol abuse, serum levels of sodium, potassium and glucose, and co morbidities), perioperative factors (type of surgery and anesthesia, and duration of surgery) and postoperative data (length of stay in recovery room, severity of pain and use of opioid analgesics) were retrospectively collected and statistically analyzed.

Results

POD appeared in 48 patients (21.4%) by postoperative day 3. When we excluded 26 patients with previous dementia or delirium, 17 spontaneously recovered by postoperative day 14, while 5 patients recovered by postoperative 2 months with medication, among 22 patients with newly developed POD. The univariate risk factors for POD included previously dementic or delirious patients, abnormal preoperative serum glucose level, pre-existent diabetes, the use of local anesthesia for the operation, longer operation time (>3.2 hr) or recovery room stay (>90 min), and severe pain (VAS>6.8) requiring opioid treatment (p<0.05). Backward regression analysis revealed that previously dementic patients with diabetes, the operation being performed under local anesthesia, and severe postoperative pain treated with opioids were independent risk factors for POD.

Conclusion

Our study shows that control of blood glucose levels and management of pain during local anesthesia and in the immediate postoperative period can reduce unexpected POD and help preventing unexpected medicolegal problems and economic burdens.     

卒中患者呼吸机相关性肺炎的危险因素及护理

<正> 随着医疗技术水平和急救技术的发展,机械通气技术越来越广泛地被应用于危重患者的抢救及术后呼吸支持。呼吸机相关性肺炎[ventilator-associated pneumonia,VAP]是机械通气[不包括非创伤性]48h后或停用机     

Readmission Rates in Stroke Patients with and without Infections: Incidence and Risk Factors

BackgroundStroke patients are at increased risk for acquiring infections in the hospital and risk of readmission. We aimed to examine whether an infection acquired during the initial stroke admission contributes to increased risk of readmission and infection during readmission.MethodsWe performed a retrospective cohort study incorporating all adult ischemic stroke patients from three New York City hospitals from 2006 to 2016. A validated computer algorithm defined infections based on electronically-available laboratory culture data. Multivariable logistic regression was used to evaluate the crude and adjusted association of infections present on admission (IPOA) and healthcare-associated infections (HAI) with 60-day readmissions, and infection during readmission.ResultsAmong the 10,436 stroke patients, 17% had infections during initial admission of which 52% were IPOA and 48% were HAI. The risk of readmission was significantly higher for those with HAIs (OR = 1.40; 95% CI: 1.20–1.64) and IPOA (OR = 1.26; 95% CI: 1.09–1.47). The presence of infection during the 60-day readmission was also independently predicted by HAI (OR = 3.27; 95% CI: 2.60–4.12) and IPOA (OR = 2.54; 95% CI: 2.01–3.22). Patients with a Gram-negative infection were not at higher odds for readmission compared to patients with a Gram-positive infection (OR 1.07, 95%CI 0.81–1.42).ConclusionAmong stroke patients, HAI and IPOA were predictors of readmission within 60 days and infection during readmission.     

Incidence and Risk Factors of Infection Caused by Vancomycin-Resistant Enterococcus Colonization in Neurosurgical Intensive Care Unit Patients

Objective

This study was aimed to identify the incidence and risk factors of vancomycin-resistant enterococcus (VRE) colonization in neurosurgical practice of field, with particular attention to intensive care unit (ICU).

Methods

This retrospective study was carried out on the Neurosurgical ICU (NICU), during the period from January. 2005 to December. 2007, in 414 consecutive patients who had been admitted to the NICU. Demographics and known risk factors were retrieved and assessed by statistical methods.

Results

A total of 52 patients had VRE colonization among 414 patients enrolled, with an overall prevalence rate of 6.1%. E. faecium was the most frequently isolated pathogen, and 92.3% of all VRE were isolated from urine specimen. Active infection was noticed only in 2 patients with bacteremia and meningitis. Relative antibiotic agents were third-generation cephalosporin in 40%, and vancomycin in 23%, and multiple antibiotic usages were also identified in 13% of all cases. Multivariate analyses showed Glasgow coma scale (GCS) score less than 8, placement of Foley catheter longer than 2 weeks, ICU stay over 2 weeks and presence of nearby VRE-positive patients had a significantly independent association with VRE infection.

Conclusion

When managing the high-risk patients being prone to be infected VRE in the NICU, extreme caution should be paid upon. Because prevention and outbreak control is of ultimate importance, clinicians should be alert the possibility of impending colonization and infection by all means available. The most crucial interventions are careful hand washing, strict glove handling, meticulous and active screening, and complete segregation.     

神经外科外周中心静脉置管后静脉炎的相关因素分析

目的对神经外科患者外周中心静脉导管（PICC）置管后静脉炎的相关因素进行分析，以指导临床护理工作。方法神经外科患者256例留置PICC，对发生静脉炎的相关因素进行回顾性分析，并总结相应的护理措施。结果256例中发生静脉炎58例，发生率为22．7％。患者年龄、剧烈运动、穿刺部位、穿刺次数、置管时间及合并有外科感染性疾病等与静脉炎的发生明显相关（P〈0．05）。结论提高穿刺技巧、避免剧烈运动、选用型号恰当的导管、选择适当的位置进行置管，置管后给予积极的护理，可提高置管质量、延长置管时间，并能预防和减少静脉炎的发生。     

老年脑梗死患者下呼吸道医院感染直接经济损失研究

目的 研究老年急性脑梗死患者发生下呼吸道医院感染的直接经济损失,明确引起经济损失的各 项费用来源。 方法 采用回顾性调查分析的方法,调查2012年1月至2013年6月于老年病科住院的急性脑梗死患者 285例,选择下呼吸道医院感染患者和无医院感染患者,根据配对条件配成35对,包括病例组（下呼 吸道医院感染组）和对照组（未发生医院感染组）,比较两组间各项住院费用的差异。 结果 病例组医疗费用中位数14 193元,对照组11 913元,两组差异有显著（Z=－5.159,P＜0.001）; 住院费用中,支出费用最多是药品费用,病例组药品费用中位数8801元,对照组6642元（Z=－5.143,P ＜0.001）;病例组较对照组住院日延长,差异有显著性（Z=－5.179,P＜0.001）。 结论 老年脑梗死患者发生下呼吸道医院感染增加了直接经济损失。     

癫痫患者出生与出生后的危险因素分析

目的　调查癫痫患者在出生时与出生后的危险因素。方法　采用华盛顿癫痫心理社会问卷对 2 0 0例成年癫痫患者进行了调查 ,并与 2 0 0例正常人做了对照分析。结果　癫痫分类以全身性发作 134例 (6 7% ) ,16～ 30岁 12 0例 (6 0 % )。危险因素 :难产和产伤 (P <0 .0 5 ) ,新生儿黄疸 ,脑炎 /脑膜炎和高血压 (P <0 .0 5 ) ,发热惊厥和脑外伤 (P <0 .0 1)。家族高危因素有癫痫和偏头痛 (P <0 .0 1) ,精神病、脑中风和高血压 (P <0 .0 5 )。结论　癫痫患者出生时与出生后的危险因素与癫痫的发病密切相关。