老年患者全身麻醉气管插管后下呼吸道感染病原菌及相关因素分析  

Pathogenic bacteria causing lower respiratory tract infections in the elderly patients after treatment of tracheal intubation under general anesthesia in elderly patients and analysis of the risk factors

作　　者：杨灵君[1] 张涛[1] 狄华君[1] 陈洁[2] 

机构地区：[1]台州医院麻醉科,浙江临海317000 [2]温州医学院附属第二医院育英儿童医院感染科,浙江温州325000

出　　处：《中华医院感染学杂志》2013年第10期2334-2336,共3页Chinese Journal of Nosocomiology

摘　　要：目的探讨老年患者全身麻醉气管插管后下呼吸道感染的病原菌特点,分析造成感染的危险因素。方法将接受全麻气管插管的老年患者962例中发生下呼吸道感染的40例患者作为研究对象,对收集的痰标本做细菌培养后进行菌种鉴定与药敏试验;对年龄、性别、基础疾病、吸烟史、麻醉通气时间、术后拔管时间、术后有无镇痛等危险因素进行单因素分析及多因素logistic回归分析。结果共分离出病原菌459株,前5位病原菌分别为铜绿假单胞菌、鲍氏不动杆菌、金黄色葡萄球菌、肺炎克雷伯菌及嗜麦芽寡养单胞菌,分别占52.51%、9.58%、9.15%、6.97%、6.10%;分离菌株对抗菌药物显示出不同敏感性,对铜绿假单胞菌敏感度最高是阿米卡星,敏感率为68.88%,而氨曲南敏感度最低为36.10%;全身麻醉气管插管后下呼吸道感染的危险因素为年龄、吸烟史、肺部手术、基础疾病、麻醉通气时间以及术后拔管时间。结论在对老年患者进行全身麻醉气管插管治疗时应对危险因素进行干预,当发生感染后,应结合药敏试验进行抗菌药物选择。OBJECTIVE To explore the characteristics of lower respiratory tract infections after treatment of tracheal intubation under general anesthesia in the elderly patients and to analyze the related risk factors. METHODS A total of 40 patients with lower respiratory tract infections in 962 elderly patients who received tracheal intuhation under general anesthesia were enrolled in the study. The bacterial identification and drug susceptibility testing were preformed after the collection of sputum specimens. The univariate factor analysis and multivariate logistic regression analysis were performed to identify the risk factors for the lower respiratory tract infections after the treatment of tracheal intubation under general anesthesia, including the age, gender , underlying disease, smoking history, anesthesia ventilation time, postoperative extubation time ,and postoperative analgesia. RESULTS Totally 459 strains of pathogens were isolated, Pseudomonas aeruginosa （52. 51%）, Acinetobacter baumannii acinetobacter （9. 58%）, Staphylococcus aureus （9. 15%）, Klebsiella pneumoniae （6. 97%） and Stenotrophornonas maltophilia （6.10 %） ranked the top 5 tested bacteria, and all the isolated strains varied in the drug susceptibility, the drug susceptibility rate of P. aeruginosa to amikacin was the highest （68.88%）, and the drug susceptibility rate to aztreonam was the lowest（36.10%）; the age, smoking history, pulmonary ventilation surgery, underlying diseases, anesthesia and postoperative extubation time were identified as the risk factors for lower respiratory tract infections after treatment of tracheal intubation under general anesthesia. CONCLUSION Risk factors should be intervened as the tracheal intubation under general anesthesia treatment is in progress, and the antibiotics should he chosen on the basis of the drug susceptibility testing.

关 键 词：老年 气管插管 全身麻醉 肺部感染 

分 类 号：R563.1[医药卫生—呼吸系统]