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題 名 | 冠狀動脈繞道手術之手術部位感染危險因子之探討=Risk Factors for Surgical Site infection Following Coronary Artery Bypass Surgery at a Medical Center |
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作 者 | 張智華; 王復德; | 書刊名 | 院內感染控制雜誌 |
卷 期 | 8:4 1998.08[民87.08] |
頁 次 | 頁551-564 |
分類號 | 416.262 |
關鍵詞 | 手術部位感染; 危險因子; 冠狀動脈繞道手術; 院內感染; Surgical site infection; Risk factors; Coronary artery bypass surgery; Nosocomial infection; |
語 文 | 中文(Chinese) |
中文摘要 | 心臟手術後之手術部位的感染會增加病患之罹病率、致死率、住院天數及醫療經費,因此,為了解手術部位感染發生率及探討手術部位感染相關之危險因子,本調查以前瞻性方式收集心臟血管外科從民國84年5月至86年4月二年期間,接受冠狀動脈繞道手術病人資料,共調查620個病例。手術部位總感染率為8.55%(53人次),其中胸部傷口感染率為3.23%(20人次),腿部傷口感染率為5.81%(36人次)。手術部位(含胸部及腿部)感染與無手術部位感染兩組危險因子之比較,勝算比前三位依序為:術後重新固定胸骨(12.8)、術後因出血再一次手術(4.9)、術後心輸出量降低(2.5)。胸部傷口感染與無胸部傷口感染兩組危險因子之比較,勝算比前三位依序為:術後重新固定胸骨(41.0)、術後因出血再一次手術(13.9)、術後心輸出量降低(3.8)。胸部傷口感染之危險因子進行多變項邏輯迴歸分析,統計學上有意義之因子(p<0.05)為糖尿病、術後心輸出量降低、術後因出血再一次手術、平均住院天數、使用人工心肺機時間和手術時間。 手術部位感染菌種之分佈前三位依序為金黃色葡萄球菌佔59.5%,coagulase(-)staphylococci佔27.0%,綠膿桿菌佔8.1%。依據本調查的結果,手術醫師的技術、手術時間、使用人工心肺機時間、手術後病人的照護、是否因出血再次手術、心輸出量與住院天數均是影響冠狀動脈繞道手術之手術部位感染的重要因素。 |
英文摘要 | Surgical site infections after open heart sugery contribute substantially to mobidity, mortality, added hospital stay and costs. From May, 1995 till April, 1997, we prospectively studied 620 patients who underwent coronary artery bypass surgery. The purpose of thsi study was to determine surgical site infection rate and risk factors following coronary artery bypass surgery. The overall infection rate was 8.55%, chest wound infection rate was 3.23%, and leg wound infection rate was 5.81%. The odds ratio of major risk factors in surgical site infections were as follows: rewiring of the sternal dehiscence, 12.8; reexploration for the hemorrhage, 4.9; and depressed cardiac output in the postoperative peroid, 2.5. The odds ratio of major risk factors in chest wound infections were as follow: rewiring of the sternal dehiscence, 41.0; reexploration for the hemorrhage 13.9; and depressed cardiac output in the postoperative peroid 3.8. Multiple logistic regression indicated that diabetes, depressed cardiac output in the postoperative peroid, reexploration for the hemorrhage, the length for hospital stay, the duration of cardiopulmonary bypass, and the duration of operation were significantly associated with chest wound infection. The pathogens of the surgical site infection were Staphylococcus aureus (59.5%), coagulase (-) staphylococci (27.0%), P. aeruginosa (8.1%). According to the study, operation technique, duration of operation, duration of cardiopulmonary bypass, postoperation care, reexploration for the hemorrhage, cardiac output in the postoperative peroid, and hospital stay were the important risk factors. |
本系統中英文摘要資訊取自各篇刊載內容。