某肿瘤专科医院神经外科术后患者集中发热事件调查
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摘要
目的对某肿瘤专科医院神经外科术后患者集中发热的原因进行调查。方法对2015年12月1日至2016年1月31日神经外科所进行的全部手术开展流行病学调查,内容包括:患者一般情况、手术信息、用药信息、使用的器械耗材、术后临床表现等。结果期间该科共行37例手术,其中25例为颅内手术、12例为非颅内手术。25例颅内手术患者中发生持续发热者13例,发生率为52.00%,与该科室前期颅内手术后发热发生率13.79%相差较大(χ2=5.012,p=0.025);12例非颅内手术患者均无发热现象。对颅内手术病人进行调查发现,发热与未发热病人在一般情况、手术情况等方面差异均无统计学意义;进一步调查本科室前期手术病例,发现术中使用的吸收性明胶海绵厂家不同,随即停用待查。停用后再未出现类似现象。结论该院短期内患者集中发热事件系使用了新更换的吸收性明胶海绵所致,经停用后未再发生类似事件。提示临床在启用新产品初期,应注意加强对使用后反应的观察。
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.
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.
引文
1 Yeom I.Oh WO.Kim DS,et al.Effect of Unshaven Hair with Absorbable Sutures and Early Postoperative Shampoo on Cranial Surgery Site Infection[J].Pediatr Neurosurg,2017,53(1):18-23.
2牟霞,杨怀,王建怡.一起神经外科手术部位感染暴发的调查[J].中国医学科学院学报,2017,39(2):225-229.
3 Dai Y,Zhang C,Ma X,et al.Outbreak of carbapenemase-producing Klebsiella pneumoniae neurosurgical site infections associated with a contaminated shaving razor used for preoper-ative scalp shaving[J].Am J Infect Control,2014,42(7):805-806.
4常彦敏,潘军,孙明月.一起神经外科肺炎克雷伯菌医院感染暴发分析[J].中国消毒学杂志,2017,34(4):393-394.
5殷环,赵秀莉,李六亿.某三级甲等综合医院感染经济损失的研究[J].中华医院感染学杂志,2014,24(21):5393-5395.
6王涛徐明,史中华,陈光强.神经外科幕上手术术后颅内感染的发生率及危险因素调查[J].中华神经外科杂志,2014,30(12):1249-1252.
7孙才兴,孟旭莉,谢尚闹.脑肿瘤患者开颅术后并发脑膜炎的危险因素分析[J].中华临床感染病杂志,2010,3(3):182-185.
8 Le TA,Dibley MJ,Vo VN,et al.Reduction in surgical site infections in neurosurgical patients associated with a bedside hand hygiene program in Vietnam[J].Infect Control Hosp Epidemiol,2007,28(5):583-588.
9杜明梅,邢玉斌,索继江.脑室镜引起手术后颅内感染暴发的监测与控制[J].中华医院感染学杂志,2011,21(21):4478-4480.
2牟霞,杨怀,王建怡.一起神经外科手术部位感染暴发的调查[J].中国医学科学院学报,2017,39(2):225-229.
3 Dai Y,Zhang C,Ma X,et al.Outbreak of carbapenemase-producing Klebsiella pneumoniae neurosurgical site infections associated with a contaminated shaving razor used for preoper-ative scalp shaving[J].Am J Infect Control,2014,42(7):805-806.
4常彦敏,潘军,孙明月.一起神经外科肺炎克雷伯菌医院感染暴发分析[J].中国消毒学杂志,2017,34(4):393-394.
5殷环,赵秀莉,李六亿.某三级甲等综合医院感染经济损失的研究[J].中华医院感染学杂志,2014,24(21):5393-5395.
6王涛徐明,史中华,陈光强.神经外科幕上手术术后颅内感染的发生率及危险因素调查[J].中华神经外科杂志,2014,30(12):1249-1252.
7孙才兴,孟旭莉,谢尚闹.脑肿瘤患者开颅术后并发脑膜炎的危险因素分析[J].中华临床感染病杂志,2010,3(3):182-185.
8 Le TA,Dibley MJ,Vo VN,et al.Reduction in surgical site infections in neurosurgical patients associated with a bedside hand hygiene program in Vietnam[J].Infect Control Hosp Epidemiol,2007,28(5):583-588.
9杜明梅,邢玉斌,索继江.脑室镜引起手术后颅内感染暴发的监测与控制[J].中华医院感染学杂志,2011,21(21):4478-4480.