老年患者腹部手术与麻醉相关肺部感染病原学分析与控制

Etiological analysis of anesthesia-related pulmonary infections in elderly patients undergoing abdominal surgery and control measures

目的分析老年患者腹部手术全身麻醉后肺部感染的病原学及预防对策,为降低老年患者术后肺部感染提供试验数据和临床经验。方法对2010年4月-2013年6月200例腹部手术全身麻醉的老年患者临床资料进行分析,根据术后是否发生肺部感染分为感染组40例和非感染组160例,同时分析肺部发生感染的原因、感染率及感染病原菌;并依据感染原因提出针对性的预防和治疗措施,采用SPSS15.0软件进行统计分析。结果 200例患者中发生肺部感染40例,感染率20.0%,感染的主要因素是侵入性操作、合并呼吸道疾病、控制麻醉易感因素不当、术后处理不合理等;40例感染患者痰培养出病原菌40株,以革兰阴性菌为主占60.0%,其次是革兰阳性菌占30.0%,真菌占10.0%,主要感染病原菌为铜绿假单胞菌、金黄色葡萄球菌、大肠埃希菌,分别占45.0%、15.0%、10.0%。结论做好术前的准备、术中的操作规范、术后的合理及时护理措施,能有效地预防老年术后的肺部感染的发生。

OBJECTIVE To analyze the etiology of pulmonary infections in elderly patients after systemic anesthesia for abdominal surgery and put forward prevention countermeasures so as to reduce incidence of postoperative pulmonary infections in the elderly patients. METHODS The clinical data of 200 elderly patients who underwent the abdominal surgery under systemic anesthesia from Apr 2010 to Jun 2013 were analyzed, then the subjects were divided into the infection group with 40 cases and the non-infection group with 160 cases according to the status of pulmonary infections, the causes of pulmonary infections, infection rate, and pathogens causing infections were observed, the targeted prevention and treatment measures were proposed according to the causes of infections, and the statistical analysis was performed with the use of SPSS15. 0 software. RESULTS Of the 200 patients, the pulmonary infections occurred in 40 cases with the infection rate of 20.0 ~//00 ; the main causes of infections included the invasive operation, complication of respiratory tract disease, inappropriate control of predisposing factors of anesthesia, and unreasonable postoperative treatment. Totally 40 strains of pathogens have been isolated from sputum culture of the 40 patients with infections, among which the gram-negative bacteria accounted for 60.0N, the gram-positive bacteria 30.0~, the fungi 10.0N; the Pseudomonas aeruginosa, Staphylococcus aureus, and Escherichia coli were the predominant species of pathogens causing infections, accounting for 45.0~, 15.0N, and 10. 0~, respectively. CONCLUSION The well-done preoperative preparation, standardized intraoperative operation, and reasonable and timely postoperative nursing may effectively prevent the postoperative pulmonary infections in the elderly patients.