气管内插管和喉罩麻醉对手术儿童下呼吸道感染的影响  

Influence of endotracheal intubation and laryngeal mask anesthesia on lower respiratory tract infections in surgery children

作　　者：刘琼[1] 许铿[1] 李建[1] 陈燕娥[1] 吴学礼[1] 

机构地区：[1]海口市妇幼保健院麻醉科,海南海口570203

出　　处：《中华医院感染学杂志》2017年第17期4024-4027,共4页Chinese Journal of Nosocomiology

基　　金：海南省自然科学基金资助项目(20158312)

摘　　要：目的探究气管内插管和喉罩麻醉两种气道管理方式对手术儿童发生下呼吸道感染的影响。方法选取2014年1月-2016年1月于医院择期进行手术的106例患儿为研究对象,分析气管内插管和喉罩麻醉后感染情况;将患儿按照随机数表法进行分组,每组各53例;对照组患儿置入气管内插管,观察组患儿置入喉罩;术后3d比较两组患儿中咳嗽、发热、肺部闻及粗湿啰音发生情况;术后10min观察并统计两组患儿中恢复自主呼吸的患儿数量及比例,术后20min统计两组患儿中拔管患儿数量及比例;统计气管内插管和喉罩麻醉后下呼吸道感染发生情况;采集感染患儿临床样本进行病原菌培养及鉴定。结果术后3d对照组咳嗽5例(9.43%)、发热9例(16.98%)、肺部闻及粗湿啰音6例(11.32%);观察组咳嗽1例(1.89%)、发热3例(5.66%)、肺部闻及粗湿啰音2例(3.77%),两组比较差异有统计学意义(P<0.05);10min后恢复自主呼吸患儿数量及比例为对照组45例(84.91%),观察组48例(90.57%);20min后拔管患儿数量及比例为对照组24例(45.29%)、观察组23例(43.40%),两组比较差异无统计学意义;106例患儿中共有23例发生下呼吸道感染,感染率为21.70%;其中对照组15例(28.30%),观察组8例(15.09%),两组比较差异有统计学意义(P<0.05);共检出病原菌45株,其中革兰阴性菌34株占75.56%,革兰阳性菌7株占15.55%,感染病原菌以铜绿假单胞菌、肺炎克雷伯菌、鲍氏不动杆菌为主,分别占31.11%、20.00%、13.33%。结论气管内插管和喉罩麻醉两种气道管理方式均会引起一定的下呼吸道感染,且气管内插管引起的下呼吸道感染率高于喉罩。OBJECTIVE To explore the influence of two airway management approaches endotracheal intubation and laryngeal mask anesthesia on lower respiratory tract infections in surgery children.METHODS A total of 106 children who received selective surgery in the hospital from Jan 2014 to Jan 2016 were recruited as the study subjects,and the incidence of infections was analyzed after endotracheal intubation and laryngeal mask anesthesia.The enrolled children were randomly grouped,with 53 cases in each group.The children of the control group were inserted with endotracheal tube,and the children of the observation group were inserted with laryngeal mask.The incidence rates of cough,fever and lung smell and rough wet rales were compared between the two groups of children after the surgery for 3 days,the number and proportions of the children with restoration of spontaneous breathing were observed and statistically analyzed after the surgery for 10 minutes,the number and proportions of the children with extubation were statistically analyzed after the surgery for 20 minutes,the incidence of lower respiratory tract infection was statistically analyzed after the endotracheal intubation and laryngeal mask anesthesia,the clinical specimens that were obtained from the children with infection were cultured,and the isolated pathogens were identified.RESULTS After the surgery for 3 days,there were 5（9.43%）cases of cough,9（16.98%）cases of fever and 6（11.32%）cases of lung smell and rough wet rales in the control group,and there was 1（1.89%）case of cough,3（5.66%）cases of fever and 2（3.77%）cases of lung smell and rough wet rales in the observation group（P〈0.05）.There were 45（84.91%）children who restored spontaneous breathing in the control group 10 minutes later and 48（90.57%）in the observation group;ther were 24（45.29%）children who were extubated in the control group 20 minutes later and 23（43.40%）in the observation group,and there was no significant difference between the two groups.Totally 2

关 键 词：气管内插管 喉罩麻醉 儿童 下呼吸道感染 影响 

分 类 号：R563[医药卫生—呼吸系统]