食管肿瘤行气管插管全麻术后肺部感染临床分析

Pulmonary infections caused by tracheal intubation general anesthesia for esophageal neoplasms

目的探讨食管肿瘤行气管插管全麻术后造成肺部感染的影响因素,为临床防治提供依据。方法将医院2006年2月-2011年1月收治的5938例食管肿瘤行气管插管全麻患者临床资料进行总结,分别对患者的既往、术前状况、麻醉及气管导管类型、痰培养结果进行分析。结果入选病例共5938例,术后肺部感染共786例,占13.24%;组间比较年龄、麻醉时间、导管类型差异有统计学意义;观察组患者经细菌学检查分离病原菌128株,依次为鲍氏不动杆菌、铜绿假单胞菌、金黄色葡萄球菌、肺炎克雷伯菌、大肠埃希菌、非发酵菌分别占37.5%、18.8%、14.8%、12.5%、7.0%、9.4%。结论食管肿瘤行气管插管全麻术后肺部感染发生率较高,影响因素与年龄、麻醉时间、气管导管类型有关,对患者术后合理应用抗菌药物、慎重选择气管导管及侵入性操作对预防其发生肺部感染有重要意义。

OBJECTIVE To explore the related factors for the pulmonary infections caused by tracheal intubation general anesthesia for esophageal neoplasms so as to provide bases for clinical prevention. METHODS The clinical data of 5938 esophageal tumor patients who underwent tracheal intubation general anesthesia from Feb 2006 to Jan 2006 were summarized, the previous status, preoperative status, the type of anesthesia and endotracheal tube, and the sputum culture were observed. RESULTS A total of 5938 patients were enrolled the case study, postoperative pulmonary infections occurred in 786 cases （13.24%）; the difference in the age, duration of anesthesia, and the type of catheter was statistically significant; totally 128 strains of pathogens were isotated from the patients in the observation group by bacteriological examination, among which Acinetobacter baumannii, Pseudomonas aerugino- sa, Staphylococcus aureus, Klebsiella pneumonia, and Escherichia coli accounted for 37.5%, 18.75 %, 14.84 %, 12.5%, 7. 03%, and 9. 38%, respectively. CONCLUSION The incidence of pulmonary infections caused by tracheal intubation general anesthesia for esophageal neoplasms is relatively high, which may relate to the age, duration of anesthesia, and the type of tracheal catheter. It is of great significance in the prevention of pulmonary infections to reasonably use antibiotics and carefully select the tracheal catheter and the invasive operation.