全麻气管插管相关肺部感染的因素分析及控制措施

Risk factors and control strategy for general anesthesia tracheal intubation related pulmonary infection

目的分析全麻气管插管相关肺部感染的高危因素,并采取相应的控制措施。方法 777例全麻手术患者来自普外科2010年住院患者,随机分为两组:对照组术前不采取特殊处理;质控组术前采用自行设计的质量控制措施,内容包括术前口腔护理、术后呼吸道管理、围手术期合理使用抗菌药物等;观察两组患者术后1周肺部感染的发生率。结果 391例对照组患者中,术后1周发生肺部感染54例,感染例次率为13.8%;而386例质控组患者术后1周发生肺部感染仅21例,感染率为5.4%,质控组患者肺部感染发生率显著低于对照组,差异有统计学意义(P<0.05)。结论术前口腔护理、术后呼吸道管理、合理使用抗菌药物、以及插管过程中气道管理是质量控制的重点,也是降低肺部感染发生的重要环节。

OBJECTIVE To investigate risk factors of general tracheal intubation related pulmonary infection,and to take the corresponding control measures in hospitalized patients in our general surgery department.METHODS A total of 777 hospitalized patients needing general anesthesia tracheal intubation surgery from our general surgery department were randomly divided into two groups：the patients were nottaken any special control measures before operation and self designing quality control measures were taken including oral nursing care before operation,respiratory tract management after operation and reasonable use of antibiotics in the perioperative period.The incidence rate of pulmonary infections was observed during 1 week after operation.RESULTS Pulmonary infection was occurred in 64 of 391 control patients during 1 week after operation,the infection rate was 13.8%.While pulmonary infection was occurred in 21 of 386 quality-control patients,the infection rate was 5.4%.The pulmonary infection rate was significantly lower in Quality-control group than that of control group（P〈0.05）.CONCLUSION Oral nursing care before operation,respiratory tract management after operation and reasonable use of antibiotics are the key for quality control to prevent the occurrence of general tracheal intubation related pulmonary infection.