60例气管插管全麻诱导术后患者下呼吸道感染的危险因素分析及干预策略  

Analysis on Risk Factors of LRTI in 60 Patients after Endotracheal Intubation induction and Its Countermeasures

作　　者：李斌[1] LI Bin(Department of Anesthesiology,The No.1 Hospital Affiliated to Gannan Medical College,Ganzhou Jiangxi 341000,China)

机构地区：[1]赣南医学院第一附属医院麻醉科,江西赣州341000

出　　处：《抗感染药学》2020年第11期1656-1659,共4页Anti-infection Pharmacy

摘　　要：目的:分析气管插管全麻诱导术后患者下呼吸道感染(lower respiratory tract infection,LRTI)的危险因素及其干预策略。方法:选取医院2018年8月—2020年2月间收治的气管插管全麻诱导术患者617例资料,其中60例术后出现LRTI(感染组),557例未出现感染(非感染组),分析感染组患者标本中细菌培养结果与LRTI相关性,并采用多因素Logistic回归方程分析产生的因素及其对策。结果:感染组患者年龄(≥45岁)、麻醉时间(≥3 h)、插管方法(明视)、插管途径(口腔)、拔管时间(≥3 h)与气管插管全麻诱导术后发生LRTI相关,构成了独立危险因素(P<0.05);感染组干预前60例患者标本中培养出病原菌73株,干预后培养出病原菌31株。结论:全麻诱导术后患者,LRTI的发生与革兰阴性菌(铜绿假单胞菌、肺炎克雷伯菌)感染、年龄(≥45岁)、麻醉时间(≥3 h)、插管方法(明视)、插管途径(口腔)、拔管时间(≥3 h)有关,也是造成其感染的独立危险因素,通过有效咽部口腔护理、体位护理、呼吸道护理有助于减少病原菌的产生,预防其感染。Objective:To analyze the risk factors of lower respiratory tract infection(LRTI)in patients undergoing general anesthesia after endotracheal intubation and to propose intervention strategies.Methods:A total of 617 patients admitted to our hospital for induction of tracheal intubation under general anesthesia from August 2018 to February2020 were selected.Among them,60 patients showed LRTI after operation(infection group)and 557 patients showed no infection(non-infection group).The correlation between bacterial culture results and LRTI in specimens of patients in the infected group was analyzed.The factors and countermeasures were analyzed by multivariate Logistic regression equation.Results:Age(greater than or equal to 45 years old),duration of anesthesia(greater than or equal to 3 h),intubation method(visual),intubation route(oral cavity),and extubation time(greater than or equal to 3 h)of patients in the infection group were correlated with the occurrence of LRTI after endotracheal intubation induced by general anesthesia,which constituted independent risk factors(P<0.05).In the infection group,73 strains of pathogenic bacteria were cultured from the samples of 60 patients before intervention,and 31 strains were cultured after intervention.Conclusion:After induction of general anesthesia surgery,the occurrence of LRTI and Gram negative bacteria(Pseudomonas aeruginosa,Klebsiella pneumoniae)infection,age(greater than or equal to 45)or higher,anesthesia time(3 h)or higher,intubation method(bright),way(oral)intubation and extubation time(3 h)or higher,and caused its independent risk factors of infection,through effective pharyngeal oral care,body position nursing,airway nursing helped to reduce pathogenic bacteria,to prevent the infection.

关 键 词：气管插管 全麻诱导 下呼吸道感染 危险因素 

分 类 号：R197.323.4[医药卫生—卫生事业管理]