不同麻醉方式与下呼吸道感染的关系  

Relationship between types of anesthesia and lower respiratory tract infections

作　　者：徐恒艺[1] 王钱荣[1] 姚煜明[1] 

机构地区：[1]湖州市中心医院麻醉科,浙江湖州313000

出　　处：《中华医院感染学杂志》2013年第7期1582-1583,共2页Chinese Journal of Nosocomiology

摘　　要：目的探讨不同麻醉方式与下呼吸道感染的相关性,通过减少全身麻醉以降低下呼吸道感染率,为提高临床麻醉质量提供指导。方法回顾性分析2267例妇科手术患者,制定统一调查表格,分析麻醉方式与下呼吸道感染的关系及病原菌特点。结果发生下呼吸道感染共52例,感染率为2.29%;气管内插管全麻的下呼吸道感染率为2.76%,明显高于硬膜外麻醉和腰硬联合麻醉的0.61%和0.99%,差异均有统计学意义(P<0.05);硬膜外麻醉和腰硬联合麻醉的感染率比较差异无统计学意义;手术时间≥2h和<2h的感染率分别为4.08%和1.63%,差异有统计学意义(P<0.05);ASA分级Ⅰ、Ⅱ和Ⅲ级的感染率分别为1.82%、3.11%和5.15%,差异有统计学意义(P<0.05);革兰阴性菌43株占82.69%,革兰阳性菌9株占17.31%;分布最多的为肺炎克雷伯菌、铜绿假单胞菌,分别占28.85%和23.08%。结论气管插管全麻的下呼吸道感染率较高,并且与手术时间和ASA分级也有一定关系,革兰阴性菌是主要病原菌。OBJECTIVE To discuss the relationship between the different types of anesthesia and the lower respiratory tract infections so as to reduce the incidence of the lower respiratory tract infections and improve the quality of the clinical anesthesia. METHODS The clinical data of 2267 cases of patients who underwent the cesarean delivery were studied retrospectively. The relationship between the types of anesthesia and the lower respiratory tract infections and the pathogen features were investigated by the unified survey. RESULTS The lower respiratory tract infections occurred in 52 cases with the infection rate of 2. 29%. The incidence of the lower respiratory tract infections under the general anesthesia of endotracheal intubation was 2.76 %, significantly higher than 0.61% under the epidural anesthesia and 0. 99% under the combined spinal and epidural anesthesia , the difference was statistically significant （P%0.05）, the difference in the incidence of infections between the epidural anesthesia and the combined spinal and epidural anesthesia was not statistically significant. The incidence of the infections was 4.08% in the patients with the operation duration more than 2 hours, 1.63% in the patients with the operation duration less than 2 hours, the difference was statistically significant（P〈0.05）. The incidence of the infections was 1.82% in the patients with the ASA of I , 3.11% in the patients with the ASA of II , and 5.15% in the patients with the ASA of III, the difference was statistically significant（P〈0.05）. There were 43 （82.69%） strains of gram-negative bacteria and 9 （17. 31%） strains of gram--positive bacteria; the Klebsiella pneumoniae and Pseudomonas aeruginosa were the predominant species of pathogens, accounting for 28.85 % and 23.08 %, respectively. CONCLUSION The incidence of the lower respiratory tract infections is high in the patients who underwent endotracheal intubation under general anesthesia, there is certain correlation between the incidence of the infections and

关 键 词：麻醉方式 下呼吸道感染 相关因素 全身麻醉 

分 类 号：R181.32[医药卫生—流行病学]