全麻术后患者呼吸系统医院感染临床特点及影响因素分析  

Clinical characteristics and influencing factors of nosocomial infections of respiratory system after general anesthesia

作　　者：王秀清[1] 韩明芬[1] 万群[1] 张月玲[1] 王爱华[1] 

机构地区：[1]滨州市人民医院手术室,山东滨州256610

出　　处：《中华医院感染学杂志》2015年第4期874-876,共3页Chinese Journal of Nosocomiology

基　　金：山东省自然科学基金资助项目(Y2006C02)

摘　　要：目的探讨气管插管全麻手术后患者呼吸系统医院感染临床特点及影响因素,为降低感染提供依据。方法收集2011年6月-2014年6月行气管插管全麻手术的1 200例患者临床资料,记录患者医院感染率,并对病原菌种类、影响感染的危险因素进行分析。结果 1 200例气管插管全麻手术患者术后发生呼吸系统感染42例,感染率3.50%;其中上呼吸道感染13例占30.95%、下呼吸道感染29例占69.05%;共检出病原菌58株,其中革兰阳性菌34株占58.63%、革兰阴性菌19株占32.75%、真菌5株占8.62%;单因素分析显示,年龄大、全麻时间长、术后导管留置时间长、具有吸烟史、无手术镇痛以及神经系统手术患者呼吸系统医院感染率越高,差异有统计学意义(P<0.05);多因素分析结果显示,无术后镇痛患者医院感染率显著升高,全麻时间长、导管留置时间长、年龄大,发生呼吸系统医院感染的风险越高,差异有统计学意义(P<0.05)。结论气管插管全麻患者呼吸系统医院感染的主要病原菌为革兰阳性菌,无术后镇痛、全麻时间长、导管留置时间长、年龄大是导致感染的独立危险因素。OBJECTIVE To explore the clinical characteristics and influencing factors of nosocomial infections of respiratory system after general anesthesia with tracheal intubation so as to provide reference for reducing infections.METHODS Clinical data were collected of 1 200 patients undergoing general anesthesia with tracheal intubation from Jun.2011 to Jun.2014.The nosocomial infection rate was recorded,and the infectious pathogens and influencing risk factors were analyzed.RESULTS In 1 200 cases of patients with general anesthesia,42 cases had postoperative respiratory system infections with the infection rate of 3.50%,including 13cases（30.95%）of upper respiratory tract infections,29cases（69.05%）of lower respiratory tract infections.Totally 58 strains of pathogenic bacteria of nosocomial infections were detected,including 34strains（58.63%）of gram positive bacteria,19strains（32.75%）of gram negative bacteria,5strains（8.62%）of fungi.The univariate analysis showed that the nosocomial infection rate was significantly high in patients with old age,long duration of general anesthesia and postoperative catheter indwelling,smoking history,no operative analgesia and nervous system operation（P〈0.05）.The multivariate analysis showed significantly increased nosocomial infection rate in patients without postoperative analgesia.The risk of nosocomial infections of the respiratory system was significantly high in patients with longer duration of general anesthesia and catheter indwelling and older age（P 0.05）.CONCLUSIONThe main pathogenic bacteria for nosocomial infections of respiratory system in patients undergoing general anesthesia with tracheal intubation were gram positive.Abolishment of postoperative analgesia,long duration of general anesthesia and catheter indwelling and old age were the independent risk factors for infections.

关 键 词：气管插管全麻 呼吸系统 医院感染 影响因素 

分 类 号：R181.32[医药卫生—流行病学]