骨科老年患者全身麻醉术后并发肺部感染的相关因素分析

Pathogenic bacteria causing lower respiratory tract infections in the elderly orthopedics patients after general anesthesia and analysis of the risk factors

目的：观察骨科老年患者全身麻醉术后肺部感染的发生率，并对导致感染的危险因素进行筛选和分析。方法将骨科接受全身麻醉的479例老年患者中发生术后肺部感染的45例作为研究对象，对年龄、性别、吸烟史、慢性呼吸系统疾病、心血管疾病、糖尿病、精神系统疾病以及导管类型、麻醉持续时间、术后拔管时期、术后有无镇痛等危险因素进行单因素分析及多因素 Logistic 回归分析。结果吸烟史（Wald ＝5.058，OR ＝4．618）、慢性呼吸系统疾病（Wald ＝37．950，OR ＝20．507）、精神系统疾病（Wald ＝26．303，OR ＝75．644）、全身麻醉所用导管类型（Wald ＝9．035，OR ＝11．758）、麻醉持续时间（Wald ＝15．035，OR ＝20．163）、术后拔管时期（Wald ＝14．243，OR ＝12．613）等因素是骨科老年患者全身麻醉术后肺部感染的独立危险因素（均 P ＜0．05）。结论对骨科在全身麻醉下行手术治疗的老年患者应对危险因素进行干预，当发生感染后，应结合药敏试验进行抗菌药物选择。

Objective To explore the incidence rates of lower respiratory tract infections after general anes-thesia in the elderly orthopedics patients and to analyze the related risk factors.Methods A total of 45 patients with lower respiratory tract infections in 479 elderly orthope -dics patients who received general anesthesia were enrolled in the study.The bacterial identification and drug susceptibility testing were preformed after the collection of sputum specimens.The univariate factor analysis and multivariate logistic regression analysis were performed to identify the risk factors for the lower respiratory tract infections after general anesthesia,including the age,gender,smoking histo-ry,chronic respiratory diseases history,basic cardiovascular disease,diabetes,mental disease,and endotracheal tube type,anesthesia ventilation time,postoperative extubation time,and postoperative analgesia.Results Smoking history （Wald =5.058,OR =4.618）,chronic respiratory diseases history（Wald =37.950,OR =20.507）,mental disease （Wald =26.303,OR =75.644）,endotrac heal tube type（Wald =9.035,OR =11.758）,anesthesia（Wald =15.035, OR =20.163）and postoperative extubation time（Wald =14.243,OR =12.613）were identified as the risk factors for lower respiratory tract infections after general anesthesia in the elderly orthopedics patients （all P 〈0.05 ）. Conclusion Risk factors should be intervened in elderly orthopedics patients who receive general anesthesia,and the antibiotics should be chosen on the basia of the drug susceptibility testing.