气管插管全麻手术患者术后肺部感染的相关因素及预防对策

Risk factors for nosocomial pulmonary infections after tracheal intubation under general anesthesia

目的对气管插管全麻手术患者术后肺部感染的相关危险因素进行分析,为临床预防提供参考。方法回顾性分析2012年1月-2013年3月320例气管插管行全麻手术的患者临床资料,根据其术后是否发生肺部感染分为感染组20例、非感染组300例;对感染病原菌进行分析,所有数据采用SPSS17.0进行统计处理。结果 320例患者中有20例患者术后发生肺部感染,感染率为6.3%;20例患者共分离检出44株病原菌,其中革兰阴性菌27株占61.4%,革兰阳性菌13株占29.5%,真菌4株9.1%;患者年龄≥60岁、手术种类(急症)、COPD病史、糖尿病史、吸烟史、全麻时间≥4h及插管时间≥2h与术后肺部感染的发生存在密切相关性(P<0.05)。结论年龄、急症手术、COPD病史、全麻时间及插管时间的延长严重影响气管插管全麻手术患者肺部感染,对该类患者术前需要进行充分的评估,及时进行干预,以降低肺部感染的发生。

OBJECTIVE To investigate the risk factors of nosocomial pulmonary infections after tracheal intubation under general anesthesia and provide reference for clinical prevention.METHODS Clinical data of 320 patients undergoing tracheal intubation with general anesthesia from Jan.2012 to Mar.2013 were retrospectively analyzed.According the occurrence of postoperative pulmonary infections,the patients were divided into the infection group（n=20）and the non-infection group（n=300）.The pathogenic bacteria were analyzed,and all data were processed with SPSS 17.0.RESULTS Totally 20 in 320patients had postoperative pulmonary infections,the incidence of infection was 6.25%.A total of 44 strains were detected from the 20 patients,including 27strains（61.4%）of gram-negative bacteria,13strains（29.5%）of gram positive bacteria,4strains（9.1%）of fungi.Age≥60years,surgery types（emergency）,a history of COPD,diabetes,and smoking and general anesthesia time≥4h and intubation time≥ 2h were closely correlated with postoperative pulmonary infection（P0.05）.CONCLUSION There are many influencing factors for nosocomial pulmonary infection resulted from the operation with tracheal intubation under general anesthesia.The main risk factors are age,emergent surgery,history of COPD,duration of general anesthesia,and ventilation time.Adequate assessment before surgery and timely intervention should be conducted to reduce pulmonary infection.