贺玉兰 鲁灵 周小莉

[摘要]目的：分析眼瞼成形术后医院感染的危险因素，探讨降低术后医院感染措施，以期降低眼睑成形术后感染率，提升眼睑成形术的安全性。方法：回顾性分析2016年1月-2018年1月在笔者医院行眼睑成形术1683例患者的临床资料，按照术后是否发生医院感染，将患者分为感染组和非感染组，比较两组患者康复时间、医疗费用、患者对术后眼睑美容效果满意率。比较患者个体资料、手术资料、术后康复护理执行情况的不同水平患者并发术后医院感染的几率并比较，分析影响眼睑成形术后医院感染的相关因素，将差异有统计学意义的指标纳入多因素Logistic回归方程，分析眼睑成形术后医院感染的危险因素。探讨眼睑成形术后医院感染的防治对策。结果：感染组术后康复时间、医疗费用均明显高于未感染组，且术后眼睑美容效果满意率明显低于未感染组，差异有统计学意义（P<0.05）。相关性分析显示，手术方式、手术时间、相邻手术间隔时间、手术医师眼睑成形术台数、手术室洁净级别、术后康复遵医情况为影响眼睑成形术患者术后医院感染的相关因素。多因素Logostic分析显示，切开成形术、相邻手术间隔时间≤1h、手术医师眼睑成形术≤10台、手术时间≥2h、术后康复措施遵医率<30%（OR=4.239、3.459、3.695、4.026、4.437）为眼睑成形术后医院感染的独立危险因素。结论：眼睑成形术后并发医院感染危险因素较多，加强围手术期感染预防管理可避免大部分危险因素，降低术后感染率，提升手术安全性。

[关键词]眼睑成形术；医院感染；相关因素；危险因素；预防对策

[中图分类号]R622 [文献标志码]A [文章编号]1008-6455（2018）06-0035-04

Abstract： Objective To analyze the risk factors of nosocomial infection after eyelid plasty， and to explore measures to reduce postoperative nosocomial infections， so as to reduce infection rate after eyelid plasty and improve the safety of eyelid plasty. Methods 1683 cases of eyelid plastic surgery patients clinical data from January 2016 to January 2018 in our hospital were selected and retrospective analysis. They were divided into the infection group and the non-infection group according to the postoperative nosocomial infection. The recovery time， medical expenses， patient satisfaction rate of postoperative eyelid cosmetic effect of two group patients were compared. The risk of postoperative nosocomial infection in patients with different levels of individual data， surgical data and postoperative rehabilitation nursing was analyzed. The related factors affecting the hospital infection after eyelid plasty were analyzed. The multiple factor Logistic regression equation was incorporated into the multiple factor regression equation， and the hospital infection risk factors after the eyelid plasty was analyzed. To investigate the prevention and treatment of nosocomial infection after blepharoplasty. Results The postoperative recovery time and medical cost of the infection group were significantly higher than those of the non-infected group， and the satisfaction rate of postoperative cosmetic effect of patients in the infection group was significantly lower than that of the non-infected group （P<0.05）. Correlation analysis showed that operation method， operation time， the interval of the adjacent operation， the number of operating desk of the surgeon， operation room clean level， postoperative rehabilitation medicine for the effect of blepharoplasty patients related factors of hospital infection. Logostic multivariate analysis showed that incision plasty， adjacent operative interval is less than or equal to 1H， the surgeon blepharoplasty is less than or equal to 10， the operation time was 2h， postoperative rehabilitation measures compliance rate<30% （OR=4.239， 3.459， 3.695， 4.026， 4.437） for independence the hospital infection risk factors after blepharoplasty. Conclusion There are many risk factors of nosocomial infection after eyelid plasty. To strengthen perioperative infection prevention and management can avoid most of the risk factors， reduce postoperative infection rate and improve operation safety.

Key words： eyelid plasty； nosocomial infection； related factors； risk factors； preventive measures

眼部构成复杂，手术精度要求较高，围手术期导致医院感染的几率较高，成为眼科手术患者较为严重的术后并发症[1]。鉴于此，我国眼科医师协会、中华预防医学会医院感染分会等部门于2015年制定了《眼科手术管理、感染控制、消毒灭菌指南》。对眼科手术的感染管理制度、环境、手术器械耗材清洗消毒等进行了规范，以降低眼科手术的医院感染率，提升手术质量[2]。眼睑成形术是眼科美容常见手术，近年来，随着人们对整形美容需求的不断上升，眼睑成形术的手术量也增多。……