气管插管全麻术后下呼吸道感染相关因素分析

Related factors for lower respiratory tract infections after tracheal intubation general anesthesia

目的观察气管插管全麻术后下呼吸道感染的麻醉相关因素,为临床防治提供依据。方法选取2010年2月-2012年2月在医院进行外科气管插管全麻手术患者作为研究对象,根据感染与否将患者分为感染组及对照组,将暴露因子设定为经鼻途径插管、盲探插管、插管过深、插管不熟练、拔管指征不完全、拔管延迟<3h,拔管延迟>3h等7种因素,并对各相关因素进行分析。结果拔管延迟>3h,OR=3.42,插管过深,OR=2.16,插管不熟练,OR=2.04,拔管指征不完全,OR=2.19,差异均有统计学意义;拔管延迟<3h、经口腔插管、盲探插管的OR值分别为1.10、1.53、1.86,差异无统计学意义;通过计算,拔管延迟>3h、插管过深、插管不熟练、拔管指征不完全4种因素的PAR,得出麻醉因素,拔管延迟>3h占9%,插管过深占13%,插管不熟练占23%,拔管指征不完全占13%。结论在全麻术后并发下呼吸道感染的诱发因素中,插管不当及术后拔管延迟、拔管指征不完全均为重要因素。

OBJECTIVE To observe the related factors for the lower respiratory tract infections after the trachealintubation general anesthesia so as to provide basis for the clinical prevention and treatment. METHODS Thepatients who underwent tracheal intubation general anesthesia in the hospital from Feb 2010 to Feb 2012 wereselected as the study objects and were divided into the infection group and the control group; the exposure factorswere set as the nasotracheal intubation,blind intubation,over deep intubation,unskilled intubation, incompleteextubation indication, extubation extended less than 3 h,and the extubation extended more than 3 hours,therelated factors were analyzed. RESULTS The result of the study indicated that the extubation delayed more than 3h, OR=3. 42 , over deep intubation OR = 2. 16,unskilled intubation, OR = 2. 04,incomplete extubation indications, OR = 2. 19,and the difference was significant; the extubation delayed less than 3 h, OR = 1. 10,oralintubation OR = 1. 53,and blind intubation OR=l. 86,and the difference was not significant; Through the calculation, the PAR of the extubation delayed more than 3 h,over deep intubation, unskilled intubation, and incom-plete extubation indications concluded that the extubation delayed more than 3 h accounted for 9%,over deep intu-bation 13%,unskilled intubation 23%,and incomplete extubation indications 13%. CONCLUSION Among thepredisposing factors for the lower respiratory tract infections after the tracheal intubation general anesthesia, the improperintubation,extubation delayed, and incomplete extubation indications are very common.