腹部手术患儿术后发生肺部感染的危险因素及干预对策

Risk factors and intervention countermeasures for pulmonary infection in patients of children after abdominal surgery

目的探讨儿童腹部手术后肺部感染的危险因素及干预对策,为术后肺部感染的预防提供参考依据。方法回顾性分析2008年1月-2015年7月行腹部手术后肺部感染的患儿54例(肺部感染组)临床资料,按照1∶1比例随机选取同期儿童行腹部手术后未发生肺部感染的患儿54例为对照(无肺部感染组),分析结果。结果肺部感染组患者肥胖、手术部位为上腹部手术、急诊手术、麻醉为全麻、术后留置鼻胃管、联合使用抗菌药物等因素均高于无肺部感染组,两组比较差异均有统计学意义(P<0.05);非条件多因素logistic回归分析显示,肥胖、年龄小、上腹部手术、麻醉为全麻、术后留置鼻胃管、血红蛋白水平低、住院时间长是引起患儿术后发生肺部感染的独立危险因素(P<0.05)。结论患儿存在以上危险因素应积极进行干预与预防以降低术后肺部感染。

OBJECTIVE To investigate the risk factors and intervention countermeasures for pulmonary infections in patients of children after abdominal surgery, so as to provide references for the prevention of postoperative pulmo- nary infections. METHODS Clinical data of 54 children with pulmonary infection after abdominal surgery form Jan. 2008 to Jul. 2015 were retrospectively analyzed, which were set as pulmonary infection group. Another 54 cases of children without pulmonary infections after abdominal surgery were randomly selected at the same period ac- cording to the ratio of 1 ： 1, and were set as no pulmonary infection group. The results were analyzed. RESULTS The obesity surgical sites of abdominal surgery, emergency surgery, general anesthesia, postoperative nasal gas- tric tube, and combined use of antibiotics of pulmonary infection group were all significantly higher than those of no pulmonary infection group （P〈0.05）. Unconditioned multivariate logistic regression analysis showed that obe- sity, young age, abdominal surgery, general anesthesia, postoperative indwelling nasogastric tube, low hemoglo- bin level, and long hospital stay were independent risk factors for postoperative pulmonary infections （P〈0.05）. CONCLUSION Children with these risk factors should actively be intervened and prevented, and reduce the occur- rence of postoperative pulmonary infections.