不同手术体位全麻患者术后肺部感染研究  

Postoperative pulmonary infection in patients with different surgery posture and general anesthesia

作　　者：郭峰 崔俊霞 程颖 解秀霞 曹春玲 

机构地区：[1]东营市东营区人民医院麻醉科,山东东营257000 [2]东营市东营区人民医院查体中心,山东东营257000 [3]东营市东营区人民医院手术室,山东东营257000 [4]东营市东营区新区医院体检科,山东东营257000

出　　处：《中华医院感染学杂志》2016年第13期2999-3001,共3页Chinese Journal of Nosocomiology

基　　金：山东省自然科学基金资助项目(ZR2009CL018)

摘　　要：目的研究不同手术体位全身麻醉患者术后发生肺部感染的状况,为临床手术中选择合适的体位提供依据。方法选择2013年6月-2015年6月于医院进行全麻的患者120例,依照手术方式的不同,将患者分为仰卧位组和俯卧位组,各60例,分别在麻醉前、麻醉后4h及结束麻醉时对麻醉呼吸管路的储气囊口、加气口以及患者连接口3个位置实施采样,进行细菌菌落的培养,最后统计菌落的数目;对生长有菌落的培养基实施分离培养;手术后对患者实施一周的随访,观察并记录患者是否出现肺部感染。结果共采集360份标本,病原菌检出阳性78份,阳性率21.66%,其中储气囊口、加气口以及患者连接口的检出标本的阳性率分别是1.66%、45.83%、17.50%;麻醉后4h和结束麻醉时两组加气口、患者连接口检出病原菌的阳性率比较,差异有统计学意义(P<0.05);检出病原菌中革兰阴性菌占65.38%,革兰阳性菌占20.52%;术后随访显示,俯卧位组有1例肺部感染患者,肺部感染率为1.67%;仰卧位组肺部出现感染的患者有9例,感染率为15.00%,两组患者肺部感染率比较,差异有统计学上的意义(P<0.05)。结论在术中对患者进行全身麻醉时,俯卧位较仰卧位更利于一次性使用麻醉呼吸管路通气系统病原微生物定植,仰卧位会增加全身麻醉患者术后肺部感染率,故对于术后肺部感染的预防,俯卧位手术患者更有优势。OBJECTIVE To study the status of pulmonary infection in patients with general anesthesia undergoing surgery in different posture,so as to provide evidence for the selection of appropriate position in the clinical operation.METHODS A total of 120 cases of general anesthesia patients were chosen from Jun.2013 to Jun.2015 in our hospital,according to the operation mode of different patients,who were divided in supine position group and the prone position group,with 60 cases in each group.The samplegs were selected from the gas storage bag mouth,mouth filling and joint connected to the patients in the mouth of anesthesia breathing circuit,before aseptic operation,4Hafter aseptic operation and at the end of aseptic operation.The samplegs were under culture and counted.The cultures with colony were separated.After surgery,the patients were followed up for a week,and the patients were observed and recorded.RESULTS From the 360 samples,78were detected and the positive rate was21.66%.The specimens from gas storage bag mouth,mouth filling and the joint connected to the patient in the mouth were detected and positive rate respectively were 1.66%,45.83% and 17.50%.4hafter anesthesia and at the end of anesthesia,the positive rates of pathogenic bacteria got from gas storage bag mouth,mouth filling and the joint connected to the patient in the mouth were significantly different（P〈0.05）.The composition ratio of gram negative bacteria was 65.38%,and the composition ratio of gram positive bacteria was 20.52%.Postoperative follow-up showed that 1case of patients with pulmonary infection in prone position group,pulmonary infection rate was 1.67%;supine position group pulmonary infection patients was in 9cases,and the infection rate was15.00%.Compared with the rates of two groups of patients with pulmonary infection,the difference was significant（P〈0.05）.CONCLUSION During the general anesthesia in operation,prone position compared with supine position is more conducive for the pathogenic microbial colonization on the dis

关 键 词：手术体位 全麻患者 肺部感染 状况研究 

分 类 号：R563.1[医药卫生—呼吸系统]