全身麻醉与腰椎麻醉对患者术后医院感染的影响研究

Effects of general anesthesia and lumbar hemp on the postoperative nosocomial infection in patients

目的对比研究全身麻醉与腰椎麻醉对患者术后医院感染的影响,为临床手术麻醉方式的选择提供参考依据。方法选取2014年1月-2015年8月于医院进行手术的患者600例,随机分为全麻组与腰椎麻醉组各300例,全麻组行全身麻醉下手术,腰椎麻醉组行腰椎麻醉下手术,观察两组患者术后医院感染率、呼吸道感染病原菌分布及药敏试验结果。结果全麻组患者术后医院感染为10.67%,腰椎麻醉组患者术后医院感染率为5.67%,两组患者术后感染率比较差异有统计学意义(P<0.05);全麻组与腰椎麻醉组患者感染部位均以呼吸道为主,比较差异有统计学意义(P<0.05);全麻组25例呼吸道感染患者呼吸道分泌物培养出病原菌24株,其中革兰阴性菌占62.50%、革兰阳性菌占37.50%,腰椎麻醉组12例呼吸道感染患者呼吸道分泌物培养出病原菌17株,其中革兰阴性菌占52.94%、革兰阳性菌占47.06%,两组患者感染病原菌构成比较差异无统计学意义;革兰阴性菌对临床常用抗菌药物耐药率相对较低,革兰阳性菌对临床常用抗菌药物普遍耐药,对利奈唑胺耐药率较低。结论全身麻醉和腰椎麻醉对术后患者医院感染率存在影响,对感染病原菌分布无影响,全身麻醉时患者术后更容易发生医院感染。

OBJECTIVE To compare the effects of general anesthesia and lumbar hemp on postoperative nosocomial infection,so as to provide a reference for the choice of the ways of clinical anesthesia.METHODS A total of 600 cases of patients with surgery in the hospital from Jan.2014 to Aug.2014 were selected,and randomly divided into general anesthesia group and lumbar group,with 300 cases in each group.Patients in general anesthesia group had general anesthesia during surgery,and patients in lumbar hemp group had lumbar hemp during operation.The postoperative nosocomial infection rate,distribution of respiratory infection bacteria,and drug resistant result were observed.RESULTS The nosocomial infection rates of general anesthesia group and lumbar hemp group were10.67%and 5.67%,with significant difference（P〈0.05）.The main infection sites of general anesthesia group and lumbar hemp group were both respiratory tract,with significant difference（P〈0.05）.Totally 24 strains of pathogenic bacteria were isolated and cultured from 25 cases of respiratory infected patients of general anesthesia group,of which gram-negative bacteria accounted for 62.50%,and gram-positive bacteria for 37.50%.Totally 17 strains of pathogenic bacteria were isolated and cultured from 12 cases of respiratory infected patients of lumbar hemp group,of which gram-negative bacteria accounted for 52.94%,and gram-positive bacteria for 47.06%.There was no significance between the two groups of patients with constituent ratio of pathogens.Gram-negative bacteria had low clinical antimicrobial resistance rates,and gram-positive bacteria had high clinical antimicrobial resistance rates to commonly used antibiotics,only low to linezolid.CONCLUSION General anesthesia and lumbar hemp have effects on postoperative nosocomial infection,and no effect on infection pathogenic bacteria distribution.Nosocomial infection is likely to happen in general anesthesia patients after operation.