老年腹股沟嵌顿疝患者术后肺部感染的危险因素及对策

Risk factors for postoperative pulmonary infections in elderly patients with incarcerated inguinal hernia

目的分析老年腹股沟嵌顿疝患者发生术后肺部感染的危险因素，并提出相应的处理措施，为临床治疗提供依据。方法分析医院2010年5月-2012年9月年龄60-90岁行疝修补术的腹股沟嵌顿疝老年患者临床资料，对患者的疝气类型、是否合并慢性支气管炎、是否有长期吸烟史及手术方式等进行分析。结果既往患有慢性支气管炎患者术后感染发生率为35．14％，明显高于无慢性支气管炎患者发生率的10．53％；长期吸烟患者发生术后肺部感染率为44．23％，明显高于无长期吸烟史患者的12．20％；传统手术方式术后肺部感染率为41.54％，明显高于无张力疝修补术术后肺部感染率的3．57％，差异有统计学意义（P〈0．05）。结论选择无张力疝修补术手术方式、改善患者呼吸状况以及制定合理的抗感染方案可降低患者术后肺部感染发生率，利于发生肺部感染后的恢复。

OBJECTIVE To analyze the risk factors for postoperative pulmonary infections in elderly patients with incarcerated inguinal hernia and put forward corresponding treatment measures so as to guide the clinical treatment. METHODS The clinical data of the elderly patients with incarcerated inguinal hernia （aged between 60 and 90 years old） who underwent hernia repair surgery in the hospital from May 2010 to Sep 2012 were retrospectively analyzed, then the types of the hernia, complication of chronic bronchitis, long-term smoking history , and surgery types were observed. RESULTS The incidence rate of the postoperative infections in the patients with previous chronic bronchitis was 35.14 %, significantly higher than 10.53% of the patients without previous chronic bronchitis; the incidence rate of the postoperative pulmonary infections in the patients with long- term history of smoking was 44.23%, significantly higher than 12.20% of the patients without long-term history of smoking; the incidence rate of the postoperative pulmonary infections in the patients undergoing the conventional hernia surgery was 41.54%, significantly higher than 3.57% of the patients undergoing tension-free hernia repair surgery, the difference was statistically significant （P〈0. 05）. CONCLUSION To choose the tension-free hernia repair surgery, improve the respiratory status, and establish reasonable anti-infection scheme may contribute to the reduction of incidence of postoperative pulmonary infections as well as the recovery of the patients.