围手术期强化气道管理在预防肝移植术后肺部感染中的应用价值

Application value of perioperative intensive airway management in prevention of lung infection after liver transplantation

目的探讨围手术期强化气道管理在预防肝移植术后肺部感染中的应用价值。方法回顾性分析2004年1月至2014年9月在中山大学附属第三医院实施肝移植术的914例患者临床资料。所有患者均签署知情同意书,符合医学伦理学规定。患者术后均转ICU监护治疗,根据围手术期有否进行强化气道管理,分为实行气道管理组（研究组）和未实行气道管理组（对照组）。其中研究组170例,男152例,女18例;平均年龄（48±11）岁。对照组744例,男655例,女89例;年龄（49±12）岁。强化气道管理措施主要包括加强拍背咳痰和呼吸功能锻炼、保持胃肠减压引流通畅、防止误吸、湿化气道、无菌吸痰等基础护理,缩短呼吸机使用时间,麻醉清醒后12~24 h内雾化吸入布地奈德、氨溴索,必要时行纤维支气管镜吸痰治疗,保证气道痰液有效排出。比较两组患者术后1个月内的肺部感染发生率和病死率。两组感染发生率和病死率的比较采用χ2检验。结果研究组患者术后1个月的肺部感染发生率为17.1%（29/170）,明显低于对照组的28.9%（215/744）（χ2=9.91,P〈0.05）。研究组患者术后1个月的病死率为4.1%（7/170）,明显低于对照组的10.1%（75/744）（χ2=6.03,P〈0.05）。结论围手术期强化气道管理能明显降低肝移植术后肺部感染发生率和病死率。

ObjectiveTo investigate the application value of perioperative intensive airway management in prevention of lung infection after liver transplantation （LT）.MethodsClinical data of 914 patients undergoing LT in the Third Afifliated Hospital of Sun Yat-sen University between January 2004 and September 2014 were retrospectively studied. The informed consents of all patients were obtained and the local ethical committee approval had been received. All patients were transferred into ICU after LT. According to whether the intensive airway management was performed during the perioperative period, the patients were divided into the group with airway management （the study group） and the group without airway management （the control group）. Among the 170 patients of study group, 152 were males and 18 were females with the average age of （48±11） years old. Among the 744 patients of control group, 655 were males and 89 were females with the average age of （49±12） years old. The measures of intensive airway management included the basic nursing of strengthening back-slapping for excreting phlegm and respiratory function exercise,maintaining gastrointestinal decompression and clear drainage, preventing aspiration, moistening airway, aseptic suction, also included reducing the use of ventilator, giving aerosol inhalation of budesonide and ambroxol within 12-24 h after anesthetic awareness, performing sputum suction by ifberoptic bronchoscopy when necessary to ensure sputum excretion from airway. The incidence of lung infection and mortality within 1 month after LT of the two groups were compared. The infection incidence and mortality between two groups were compared using Chi-square test.ResultsThe incidence of lung infection of study group was 17.1% （29/170）, which was significantly lower than 28.9% （215/744） of control group （χ2=9.91,P〈0.05）. The mortality 1 month after LT of study group was 4.1% （7/170）, which was signiifcantly lower than 10.1%（75/744） of control group （χ2=6.03,P〈0.05）.ConclusionPerioperative intensive airway management can signiifcantly reduces the incidence of perioperative lung infection and mortality after LT.