不同手术体位对全身麻醉术后肺部感染的影响  

Influence of different operative positions on postoperative pulmonary infection in general anesthesia

作　　者：方海燕[1] 万福红[1] 梁宁[1] 

机构地区：[1]广西壮族自治区人民医院麻醉科,广西南宁530021

出　　处：《现代医药卫生》2015年第14期2095-2097,共3页Journal of Modern Medicine & Health

基　　金：广西壮族自治区医疗卫生重点科研课题(2011111)

摘　　要：目的研究麻醉机通气系统病原微生物定植特点,探讨不同手术体位对全身麻醉术后肺部感染的影响。方法选择2013年10月至2014年10月在该院择期实施全身麻醉插管手术患者70例,根据手术方式分为俯卧位组(A组)和仰卧位组(B组),各35例,分别于麻醉前、麻醉4 h、麻醉结束时对麻醉机吸气端、呼气端、储气囊口进行采样,随后接种至血液培养基中培养,分离纯化后再用微生物生化鉴定系统进行鉴定。术后对患者进行5 d随访,观察肺部感染发生情况。结果 (1)麻醉机通气系统内部环路的细菌检出率为21.43%(45/210),其中呼气端、吸气端、储气囊口的细菌检出率分别为45.71%(32/70)、17.14%(12/70)、1.43%(1/70),检出菌大多为条件致病菌。(2)麻醉4 h和麻醉结束时,两组患者麻醉机吸气端、呼气端的病原菌阳性检出率比较,差异均有统计学意义(P<0.05)。(3)A组患者肺部感染发生率明显低于B组,差异有统计学意义(P<0.05)。结论术中仰卧位较俯卧位更易增加全身麻醉术后肺部感染的发生率。Objective To study the colonization characteristics of pathogenic microorganisms in the anesthesia machine ventilation system and to investigate the influence of different operative positions on postoperative pulmonary infection in general anesthesia. Methods Totally 70 patients undergoing general intubation anesthesia in our hospital from October 2013 to October2014 were selected as the research subjects and divided into the prone position group（group A） and supine position group（group B）according to the operation modes,35 cases in each group. The sampling was taken from the suction side,expiration side and store airbags of anesthesia machine before anesthesia,at 4 h and end of anesthesia,then inoculated at the blood culture medium for conducting culture,separation and purification. The identification was performed by adopting the microorganism biochemical i-dentification system. The postoperative 5 d follow up was performed for observing the occurrence situation of pulmonary infection.Results（1）The bacterial detection rate in the internal loop of the anesthesia machine ventilation system was 21.43%（45/210）,which at the expiration side,suction side,and the store airbags were 45.71%（32/70）,17.14%（12/70） and 1.43%（1/70） respectively. The most of detected bacteria were conditional pathogenic bacteria.（2）At 4 h and end of anesthesia,the pathogenic bacterial detection rates in the two groups had statistical difference between the suction side and the expiration side（P〈0.05）.（3）The pulmonary infection rate in the group A was significantly lower than that in the group B with statistically significant difference（P〈0.05）. Conclusion The intrapoperative supine position is easier to increase the occurrence rate of postoperative pulmonary infection in the general anesthesia than the prone position.

关 键 词：仰卧位 俯卧位 体位 麻醉 全身 肺炎 细菌 

分 类 号：R656[医药卫生—外科学]