某腫瘤專科醫(yī)院神經(jīng)外科術(shù)后患者集中發(fā)熱事件調(diào)查

□ 王亞 WANG Ya 阮燕萍 RUAN Yan-ping* 黃政權(quán) HUANG Zheng-quan

Objective To investigate the cause of clustering fever event after neurosurgical surgery in a cancer hospital. Methods Epidemiological investigation was conducted on all the neurological surgeries from December 1, 2015 to January 31, 2016 about patient general information, surgery information,medication information, the use of consumables, and postoperative clinical manifestations. Results There were a total of 37 surgeries, including 25 intracranial surgeries and 12 non-intracranial surgeries. There were 13 cases of persistent fever in 25 patients with intracranial surgery, and the incidence of fever was 52.00%. The incidence was significantly different from that of 13.79% previously in the department (χ2=5.012，p=0.025). The 12 patients undergoing non-intracranial surgeries did not have fever. The investigation in the patients with intracranial surgeries showed that there was no significant difference in general information and surgery information between patients with fever and patients without. Further investigation on previous cases found that absorbent gelatin sponge used in this period was made by different manufacturers from before. And the use of absorbent gelatin sponge was stopped soon and no similar phenomenon appeared after that. Conclusion The clustering fever event was caused by the new type of absorbable gelatin sponge and similar phenomenon did not happen after stopping the use. This prompted that at the beginning of using new products, the observation of reaction after use should be strengthened.

神經(jīng)外科手術(shù)部位特殊，通常涉及開顱等較多侵入性操作，是院內(nèi)感染等不良事件高發(fā)的科室[1-4]。一旦發(fā)生感染，不僅延長住院時間、增加住院費(fèi)用，也增加了患者的生命危險(xiǎn)[5]。2016年1月中旬，某腫瘤專科醫(yī)院院感科監(jiān)測發(fā)現(xiàn)，神經(jīng)外科近一個多月的手術(shù)病人術(shù)后有多人相繼出現(xiàn)不明原因持續(xù)發(fā)熱現(xiàn)象，隨即展開流行病學(xué)調(diào)查，查找原因，采取控制措施。

對象與方法

1.調(diào)查對象。本研究考慮到保持治療醫(yī)生團(tuán)隊(duì)的前后一致性，故選擇2015年12月1日至2016年1月31日，該院神經(jīng)外科全部手術(shù)病例(25例顱內(nèi)手術(shù)+12例非顱內(nèi)手術(shù))及2015年6月1日至7月31日的29例顱內(nèi)手術(shù)病例作為研究對象。

2.調(diào)查方法。院感專職人員深入臨床，現(xiàn)場查看神經(jīng)外科、手術(shù)室、消毒供應(yīng)中心和采供中心庫房等相關(guān)科室，查看相關(guān)記錄以及訪談相關(guān)醫(yī)務(wù)人員。查閱患者病歷資料，內(nèi)容包括：一般情況、手術(shù)信息、用藥信息、使用器械、使用耗材、術(shù)后臨床表現(xiàn)等。同時，對近期神經(jīng)外科、手術(shù)室、消毒供應(yīng)中心有無人員變動、醫(yī)生換藥方式、護(hù)理人員護(hù)理方式等進(jìn)行調(diào)查。

3.數(shù)據(jù)統(tǒng)計(jì)。應(yīng)用SPSS16.0軟件對數(shù)據(jù)進(jìn)行描述分析和統(tǒng)計(jì)分析，計(jì)數(shù)資料采用χ2檢驗(yàn)，p＜0.05為差異有統(tǒng)計(jì)學(xué)意義。

結(jié)果

1.流行情況

1.1 基本情況。2015年12月1日至2016年1月31日，神經(jīng)外科共完成手術(shù)37例，其中顱內(nèi)手術(shù)25例，非顱內(nèi)手術(shù)12例。12例非顱內(nèi)手術(shù)患者均無發(fā)熱現(xiàn)象。25例顱內(nèi)手術(shù)患者中，有13例在術(shù)后1～2天出現(xiàn)不同程度的發(fā)熱癥狀，發(fā)生率52.0%，比前期(2015年6月至7月)明顯升高(4/29，13.79%)，差異有統(tǒng)計(jì)學(xué)意義(χ2=5.012，p=0.025)。……