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目的研究肝移植受体医院感染的流行病学特征,探讨其危险因素,采取有效干预措施。方法利用医院信息网络,前瞻性目标监测2007-2008年肝移植术后病例,应用病例对照研究方法,分析肝移植后发生医院感染的危险因素。结果 2007、2008年医院感染率分别为32.58%、19.90%;2008年医院感染率明显低于2007年,差异有统计学意义(P<0.01);2007年排在前5位的感染分别为肺部感染(44.18%)、上呼吸道感染(18.60%)、胆道感染(13.95%)、腹腔感染(9.30%)及Ⅱ类切口感染(4.65%),2008年分别为肺部感染(51.28%)、腹腔感染(15.40%)、上呼吸道感染(10.26%)、胆道感染(7.69%)及Ⅱ类切口感染(7.69%);多因素logistic回归分析结果显示,肝移植术后发生医院感染的主要因素为尿管插管、术前用药和气管切开。结论利用前瞻性目标监测肝移植受体医院感染的发生,可采取有针对性的干预措施,达到预防在先的目的,从而避免肝移植术后医院感染的发生。
Objective To study the epidemiological characteristics of nosocomial infections of liver transplant recipients, to explore the risk factors and to take effective interventions. Methods The hospital information network was used to prospectively monitor the cases after liver transplantation in 2007-2008. The case-control study methods were used to analyze the risk factors of nosocomial infections after liver transplantation. Results The hospital infection rates in 2007 and 2008 were 32.58% and 19.90% respectively. The infection rates in 2008 were significantly lower than those in 2007 (P <0.01). The top 5 infections in 2007 were lung (44.18%), upper respiratory tract infection (18.60%), biliary tract infection (13.95%), abdominal infection (9.30%) and type Ⅱ incision infection (4.65%). (15.40%), upper respiratory tract infection (10.26%), biliary tract infection (7.69%) and type II incision infection (7.69%). The multivariate logistic regression analysis showed that the main factors of nosocomial infection after liver transplantation were Catheterization, preoperative medication and tracheotomy. Conclusion By using prospective targets to monitor the occurrence of nosocomial infections in liver transplant recipients, targeted interventions can be taken to prevent the earlier objective of nosocomial infections after liver transplantation.