高龄患者全身麻醉气管插管术后下呼吸道感染病原学特点及危险因素分析  

Etiological characteristics and risk factors for postoperative lower respiratory tract infections in elderly patients undergoing tracheal intonation under general anesthesia

作　　者：程太平 张杰 孔令军 王强 戴海新 

机构地区：[1]河南省新乡市第二人民医院麻醉科,河南新乡453002

出　　处：《中华医院感染学杂志》2017年第21期4908-4911,共4页Chinese Journal of Nosocomiology

摘　　要：目的研究高龄患者全身麻醉气管插管术后发生下呼吸道感染的病原学特点及危险因素,制定相关预防控制措施,为临床治疗提供参考依据。方法选取2016年01月-2017年01月医院收治的400例全麻气管插管术高龄患者为研究对象,分析其病原学特点及危险因素。结果 400例高龄患者中48例发生下呼吸道感染,感染率为12.0%;感染患者下呼吸道分泌物中分离出41株病原菌,其中革兰阳性菌11株,占26.83%,革兰阴性菌28株,占68.29%,真菌2株,占4.99%;其中患者吸烟、气管插管途径、气管插管深度、手术时间、术后拔管时间、合并基础疾病均与下呼吸道感染发生率密切相关,差异具有统计学意义(P<0.05);经多因素logistic回归分析显示,气管插管途径、气管插管深度、手术时间、拔管时间、合并基础疾病为全身麻醉术后下呼吸道感染的独立危险因素(P<0.05)。结论高龄患者行全身麻醉气管插管术后发生下呼吸道感染的概率高、危险因素多,针对相关危险因素临床应进行干预,以预防下呼吸道感染发生。OBJECTIVE To explore the etiological characteristics and risk factors for postoperative lower respiratory tract infection in elderly patients undergoing tracheal intonation under general anesthesia and put forward the related prevention and control measures so as to provide guidance for clinical treatment.METHODS A total of 400 elderly patients who underwent the tracheal intubation under general anesthesia from Jan 2017 to Jan 2017 were recruited as the study objects,and the etiological characteristics and risk factors were observed.RESULTS Of the 400 elderly patients,48 had the lower respiratory tract infections,with the infection rate 12.0%.Totally 41 strains of pathogens were isolated from lower respiratory tract secretions of the patients with infections,including 11（26.83%）strains of gram-positive bacteria,28（68.29%）strains of gram-negative bacteria and 2（4.99%）strains of fungi.The incidence of the lower respiratory tract infections was closely associated with the smoking,tracheal intubation mode,depth of tracheal intubation,operation duration,postoperative extubation time and complication with underlying diseases,and there was significant difference（P〈0.05）.The multivariate logistic regression analysis indicated that the tracheal intubation mode,depth of tracheal intubation,operation duration,extubation time and complication with underlying diseases were the independent risk factors for the lower respiratory tract infection after the general anesthesia（P〈0.05）.CONCLUSION The incidence of postoperative lower respiratory tract infections is high in the elderly patients undergoing the tracheal intubation under general anesthesia,there are a variety of risk factors,and it is necessary for the hospital to take intervention measures according to the risk factors so as to prevent the lower respiratory tract infection.

关 键 词：高龄患者 全身麻醉 下呼吸道感染 病原学特点 危险因素 

分 类 号：R56[医药卫生—呼吸系统]