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目的研究下呼吸道医院感染率及危险因素暴露率的时间趋势,评价医院感染监测效果。方法对河南郑州市某省级医院1993至2000年的126665例住院患者的下呼吸道医院感染率进行前瞻性监测,应用病例对照研究和logistic回归分析方法,筛选下呼吸道医院感染的独立危险因素,并计算这些危险因素暴露率的时间趋势。结果下呼吸道医院感染率由1993年的1.20%降到2000年的0.60%;logistic回归分析结果显示下呼吸道医院感染的独立危险因素为免疫抑制剂治疗(OR=2.72)、化疗(OR=2.17)、肿瘤患者(OR=1.45)、合并慢性阻塞性肺疾病(OR=1.88)、住ICU病房(OR=3.18)、住院期间发生昏迷(OR=3.26)、气管切开(OR=14.95)、接受透析治疗(OR=5.12)和骨/腰穿刺(OR=1.82)。除慢性阻塞性肺疾病和骨/腰穿刺的暴露率呈下降趋势外,其他7个危险因素的暴露率及综合危险因素暴露率的时间趋势无显著变化。结论在大多数危险因素暴露率的时间趋势没有明显变化的情况下,医院感染的监测可降低下呼吸道医院感染的发生率。
Objective To study the time trend of lower respiratory tract infection rate and exposure rate of risk factors and to evaluate the surveillance effect of nosocomial infection. Methods A retrospective study was conducted on the prevalence of lower respiratory tract infection in 126,665 inpatients from 1993 to 2000 in a provincial-level hospital in Zhengzhou, Henan province. Case-control studies and logistic regression analysis were used to screen for independent risk factors for nosocomial infections in lower respiratory tract. Calculate the trend of the exposure time of these risk factors. Results The rate of nosocomial infection in lower respiratory tract decreased from 1.20% in 1993 to 0.60% in 2000. Logistic regression analysis showed that the independent risk factors of nosocomial infection in lower respiratory tract were immunosuppressive (OR = 2.72), chemotherapy (OR = 2.17) (OR = 1.45), patients with cancer (OR = 1.45), patients with chronic obstructive pulmonary disease (OR = 1.88), ICU ward (OR = 3.18), coma (OR = 3.26) and tracheotomy (OR = 14.95) Dialysis (OR = 5.12) and bone / lumbar puncture (OR = 1.82). Except for chronic obstructive pulmonary disease (COPD) and bone / lumbar puncture, the exposure rate showed a decreasing trend. There was no significant change in the exposure time of other seven risk factors and the exposure rate of integrated risk factors. Conclusions Monitoring of nosocomial infections may reduce the incidence of nosocomial infections in lower respiratory tract with no significant change in the time trend of most risk factors.