| Objective:Nosocomial infection is a severity complication after the surgery of abdominal malignant tumor in digestive organs.To find its independent risk factors is important for prevention of infect.Subjects and Methods:In this study all the patients after the surgery of abdominal malignant tumor in digestive organs were selected from March 2007 to March 2009 in the First Hospital of Jinlin Universicity. Sex, age,diabetes,diagnose, The investigated variance included patients'general information,admission number, sex, age, diabetes, diagnose, hospital day presurgery, american society of anesthesiologists(ASA) grade,surgery type,surgery time,number of drainage tube,central venous cannula., hospital day postsurgery.Seach for independent risk factors.Hypothetic risk factors are summarized from the article published by"National Nosocomial Infection Surveillance (NNIS)", American in 2003.All the cases divided into 2 groups:1, oberserve group: nosocomial infectous pations were diagnosed by nosocomial infectious diagnostic criteria,2001,China Ministry of Public 2, Control group: synchronization patients after the surgery of abdominal malignant tumor in digestive organs.The definite and process of Statistic index.Reference the process in the article published by Daniel N Nan. Statistic the mean value of all the continuous variance. Demarcation by 75%,divide all the continuous variance into binary variance.So age≧68,hospitaldays presurgery≧6,surgery time≧230, drainage tubes≧3, ASA≧Ⅲ, diabetes,male is the hypothetic risk factors,they are all binary variances.Statistic the quantity of examples of the item in study contents.Summary in retrospective case control analysis. statistical treatment is executed by SPSS10.10 software.①Adopt binary Logistic regression analyse method to analyse the dependability between infection and variances.First mono factors were Logistic regression analysed one by one.Second the outcome monofactors which P<0.10 is internalized into multiple factor Logistic regression model,undergoning variance screening. Adopt Backward method(internalized criteria is P<0.05) to undertake Logistic regression.The variances which enter the Logistic regression model are the risk factors of nosocomial infection.②X2 test to calculate the odds ratio to authenticate the result.Result:In this study,1196 continuous patients undertook the surgery of abdominal malignant tumor in digestive organs.There are 87 infected patients,22 cases is mixed infection. Infected man-time is 118.Total postoperative infection rate is 7.3%.In all types of postoperative infections,The location of intection is: pulmonary infection: 38.1%;infection of biliary tract: 12.7%;infection of operative region: 11.9%.The most part of pathogen of nosocomial infections is constituted by Gram-negative bacteria, account for 45.8%. Among the total E. coli account for (22/54)40.7% in all of the Gram-negative bacteria,and is resistant to the 4th generation cephalosporin, sensitve to imipenem. Baumanii account for (11/54) 40.7% in all, drug fast pedigree and sensitive drugs is the same wth that of the E. coli. Some stains are highly sensitive to amikacin. Gram-negative bacteria mainly sampled from abdominal drainage, bile. Gram-positive bacteria account for 30.5% of all the nosocomial infections. MRSA account for (21/36)58.3% of all the Gram-positive bacteria. All the MRSA is sensitive to vancomycin, VRSA has not detected. They are mainly sampled from sputum culture and hemoculture. Fungus account for 23.7%. They are mainly sampled from swab and sputum culture.Four variances are discovered sense,including diabetes,surgery time exceed 230 minutes, hospitaldays presurgery exceed 6 days,Anaesthesia ASA grade≧III. and male, P=0.968; drainage tube≧3; age≧68, P=0.120. in P=0.05 level, we don't think it has statistical significance. Multiple factor analysis of variances of odd ratio, testified this four variances are independent risk factors in nosocomial infections.The mean hospitalday postsurgery that patients undertook the surgery of abdominal malignant tumor in digestive organs is 11. The 75% cipher is 15 day. Through the result of Logistic regression, infection and hospitalday postsurgery >15 have dependablity of statistical significance. Confirming that nosocomial infection postsurgery increase hospitalday and medical cost.Conclusion:Four variances are discovered sense, including diabetes, surgery time exceed 230 minutes, hospitaldays presurgery exceed 6 days, Anaesthesia ASA grade≧III. Nosocomial infection postsurgery increase hospitalday postsurgery.Discussion:Our study and other papers emphasize the danger of nosocomial infection after abdominal surgery. The surgery of abdominal has high risk of fatal. In our study, the incidence of nosocomial infection afer abdominal surgery of digestive organs is 7.3%. Though we haven't statistic the death rate,we stastitic the relationship between nosocomial infection and hospitalday postsurgery >15, the result is positive. Identifying the risk factors, we can find better way to prevent nosocomial infection and institute prospective project for control and cure the infection.The patients whose hospitalday presurgery >6 are mainly obstructive jaundice patients undertaking preoperative decrease jaundice procedure and liver cancer patients degrade Child grade. Patients of this kind physical statue is weak, Afer shorttime of recovery they are executed the surgery. The tolerance of surgery attack is bad. The incidence of emergency patients who occur nosocomial infection is high. The patients of this kind are mainly liver cancer rupture, gastric cancer hemorrhea and perforate patients. Although the patients of this kind don't consistent with hospitalday presurgery >6, ASA of whom is mainly V grade. Variance ASA III,IV,V grade is the marker of the bad physical statue, including emergency patients. If there are critical organs dysfunction, we can understand they can't tolerate the surgery.Because diabetes patients organism metabolic disorder for a long time, multisystem organ damage all over the body, immune function decrease. This is the reason why diabetes patients become the susceptible population and high risk group for nosocomial infection. Generally think, Dysmetabolism, vasculopathy, neuropathy, D-glucitol bypass patho-effect, et al. multifactors interaction is the reason why diabetes result in nosocomial infection.The longer the surgery time and exposure time is, the more the infection opportunity is. Unstandard operative procedure can make operative incision polluted. Surgeon procedure brutal can cause hemorrhage and region tissue severe damage. This can cause surgical site become the medium that polluted pathogen grow and proliferate. Operating room pollution is related to pollution of surgical site and infection postsurgery.We conclude from the stastistic result that dependability between postsurgery nosocomial infection and prolonged hosptital days. Generalize to the maximum,we can comprehend that nosocomial infection increase operative mortality.Through Our binary Logistic regression analyse for infection and variances, we find 4 risk factors. Diabetes, hospital day presurgery >6 day, ASA grade >III grade is easily find presurgery. We can according to this conclusion to execute high risk patients management at different levels, and to institute measures for depression of infection. For risk factor of Surgery time >230 minutes, we should discuss before surgery, estimate possible condition. Shorten the surgery time premise qualitative guarantee. |
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