全身麻醉气管插管对患者手术后呼吸道感染的影响  

Effects of tracheal intubation with general anesthesia on postoperative respiratory tract infection in patients

作　　者：吴继敏[1] 胡英[2] 金林飞[1] WU Ji-min HU Ying JIN Lin-fei(Lishui People＇s Hospital, Lishui, Zhejiang 323000, Chin)

机构地区：[1]丽水市人民医院麻醉科,浙江丽水323000 [2]丽水市中心医院手术室,浙江丽水323000

出　　处：《中华医院感染学杂志》2017年第4期880-883,共4页Chinese Journal of Nosocomiology

摘　　要：目的探讨全身麻醉气管插管对患者手术后呼吸道感染的影响,为临床预防术后呼吸道感染提供参考依据。方法回顾性分析2014年1月-2016年6月在医院行全身麻醉气管插管的患者5 166例,统计患者呼吸道感染率,病原菌分布及主要病原菌的耐药率;分析患者的性别、年龄、手术部位、麻醉通气时间、术后延迟拔管、插管熟练度以及拔管指征完全,确定患者术后呼吸道感染相关因素。结果 5 166例患者中感染196例(3.8%);感染患者共培养出病原菌224株,其中单一感染患者168例,混合感染患者28例,感染病原菌以革兰阴性菌为主165株占73.7%,革兰阳性菌54株占24.1%,真菌5株占2.2%;革兰阴性菌中铜绿假单胞菌对庆大霉素、头孢吡肟、阿莫西林、诺氟沙星的耐药率较高,对亚胺培南和美罗培南的耐药率均为0;大肠埃希菌对庆大霉素、头孢吡肟、诺氟沙星等耐药率较高,对阿米卡星、亚胺培南和美罗培南的耐药率较低;革兰阳性菌中金黄色葡萄球菌对青霉素、阿莫西林、头孢曲松和头孢唑林等耐药率较高,对苄卡西林和万古霉素的耐药率均为0,表皮葡萄球菌对青霉素、阿莫西林、头孢曲松的耐药率较高,对克林霉素、环丙沙星、苄卡西林和万古霉素等耐药率较低;不同年龄、手术部位、麻醉通气时间、术后延迟拔管、插管熟练度以及拔管指征完全均对全身麻醉气管插管患者术后呼吸道感染率有明显影响。结论临床上要对全身麻醉气管插管患者呼吸道感染的危险因素进行适当干预,降低感染率,对已经发生呼吸道感染的患者,要结合病原菌药敏试验给予合理的抗菌药物治疗。OBJECTIVE To investigate the effects of tracheal intubation with general anesthesia on postoperative respiratory tract infection in patients,so as to provide a guidance for the clinical prevention of postoperative respiratory infection.METHODS A total of 5166 patients of tracheal intubation with general anesthesia in our hospital from Jan.2014 to Jun.2016 were retrospectively analyzed,and the proportion of respiratory tract infection,pathogen distribution and drug resistance of main pathogens were statistically analyzed.The gender,age,surgical site,anesthesia ventilation time,postoperative extubation delay,intubation proficiency and extubation indications suitabitity of patients were analyzed,to determine the relevant effects of postoperative respiratory tract infection in patients with tracheal intubation general anesthesia.RESULTS Totally 196 patients had respiratory tract infection in 5166 patients,and the infection rate was 3.8%.A total of 224 cases of pathogenic bacteria were isolated,including 168 cases of patients with single infection,and 28 patients with mixed infection,among which 165 strains were gram-negative bacteria,accounting for 73.7%,54 strains were gram-positive bacteria,accounting for24.1%,and 5strains were fungi,accounting for 2.2%.Among gram-negative bacteria,Pseudomonas aeruginosa,had higher drug resistant rates to gentamicin,cefepime,amoxicillin,and norfloxacin,and was very sensitive to imipenem and meropenem,with the resistant rates of 0%;The resistant rates of Escherichia coli to gentamicin,cefepime and norfloxacin were higher,and to amikacin,imipenem and meropenem were lower.Among gram-positive bacteria,the drug resistant rates of Staphylococcus aureus to penicillin,amoxicillin,ceftriaxone and cefazolin were higher,and to benzylcacillin and vancomycin were 0%;The drug resistant rates of Staphylococcus epidermidis to penicillin,amoxicillin,and ceftriaxone were higher,to clindamycin,ciprofloxacin,benxacillin and vancomycin were lower.The rates of respiratory tract infection in patients wit

关 键 词：全身麻醉 气管插管 呼吸道感染 

分 类 号：R614.2[医药卫生—麻醉学]