气管插管全麻患者术后下呼吸道感染的病原菌分布与预防

Distribution of pathogens causing postoperative lower respiratory tract infections in patients undergoing tracheal intubation under general anesthesia and prevention measures

目的调查分析气管插管全麻患者术后发生下呼吸道感染的病原菌分布及危险因素,制定预防控制措施,以降低呼吸道感染率。方法对医院2014年1-12月收治的2 000例全麻气管插管手术患者术后呼吸道感染发生情况进行调查,分析其相关危险因素,并制定预防控制措施。结果 2 000例患者中有24例术后发生呼吸道感染,感染率为1.20%;共培养出28株病原菌,其中革兰阴性菌23株占82.14%,革兰阳性菌4株占14.29%,真菌1株占3.57%;经单因素分析,患者年龄、吸烟、术后下床活动时间、插管途径、插管深度、插管熟练程度、插管指征及拔管时间与气管插管全麻术后呼吸道感染发生率密切相关(P<0.05);经多因素logistic回归分析,年龄大、插管过深、插管不熟练、术后拔管时间为气管插管全麻术后呼吸道感染的独立危险因素(P<0.05)。结论气管插管患者行全麻术后发生下呼吸道感染的概率较高,危险因素多,临床应针对相关因素进行干预,以预防感染发生。

OBJECTIVE To investigate the distribution of pathogens causing postoperative lower respiratory tract infections in patients undergoing tracheal intubation under general anesthesia,analyze the risk factors,and put forward the prevention measures so as to reduce the incidence of respiratory tract infections.METHODS A total of2 000 patients who underwent the tracheal intubation under general anesthesia in the hospital from Jan 2014 to Dec2014were enrolled in the study,the prevalence rates of the postoperative respiratory tract infections were investigated,the related risk factors for the infections were analyzed,and the prevention measures were developed.RESULTS Of the 2 000 patients,24had the postoperative respiratory tract infections with the infection rate of1.20%.A total of 28 strains of pathogens were isolated,including 23（82.14%）strains of gram-negative bacteria,4（14.29%）strains of gram-positive bacteria,and 1（3.57%）strain of fungus.The univariate analysis indicated that the incidence of the postoperative respiratory tract infections in the patients undergoing tracheal intubation under general anesthesia was closely associated with the age,smoking,postoperative ambulation time,intubation approach,depth of intubation,proficiency of intubation,intubation indications,and extubation time（P〈0.05）.The multivariate logistic regression analysis showed that the independent risk factors for the postoperative respiratory tract infections included the old age,over deep intubation,unskilled intubation,and postoperative extubation time（P〈0.05）.CONCLUSION The probability of the lower respiratory tract infections is relatively high in the tracheal intubation patients after the genera anesthesia,and there are a variety of risk factors.It is necessary for the hospital to take interventions aiming at the related factors so as to prevent the infections.