老年患者全身麻醉后呼吸道感染的病原菌特点及危险因素分析

Etiological characteristics of respiratory tract infections in elderly patients after general anesthesia and risk factors

目的研究老年患者在全身麻醉术后呼吸道感染的发病率、病原学特点及危险因素,为积极预防提供参考。方法选择2014年2月-2016年12月在医院行全身麻醉后的486例老年患者,回顾性分析临床资料,探究呼吸道感染率及病原学特点,调查患者性别、年龄、吸烟史、肺部手术史、麻醉时间、插管途径、拔管时间、喉镜消毒方式、术前抗菌药物或激素使用、糖尿病、慢性呼吸系统疾病及术后使用呼吸机等基本情况,对呼吸道感染的危险因素进行单因素及多因素分析。结果呼吸道感染患者63例,感染率12.96%,痰培养检出病原菌64株,主要为肺炎克雷伯菌20株占31.25%、铜绿假单胞菌19株占29.69%、鲍氏不动杆菌16株占25.00%,金黄色葡萄球菌9株占14.06%;多因素logistic回归分析结果显示,年龄≥65岁、有吸烟史或肺部手术史、麻醉时间≥2.5h、经口气管插管、拔管时间≥2h、普通喉镜消毒方式、术前使用抗菌药物或激素、有糖尿病或慢性呼吸系统疾病、术后使用呼吸机等是老年患者全身麻醉后呼吸道感染的独立危险因素(P<0.05)。结论年龄、吸烟、肺部手术、麻醉时间、插管方式、喉镜消毒方式、使用呼吸机、使用抗菌药物以及合并慢性呼吸系统疾病等为老年患者全麻后呼吸道感染的独立危险因素,并证实了以肺炎克雷伯菌感染多见的病原学特点,由此形成有效的预防控制感染措施。

OBJECTIVE To investigate the morbidity rates, etiological characteristics, and risk factors for respiratory tract infections in elderly patients after general anesthesia so as to provide guidance for active prevention.METHODS A total of 486 elderly patients who received the general anesthesia in the hospital from Feb 2014 to Dec 2016 were enrolled in the study, the clinical data were retrospectively analyzed, the incidence of respiratory tract infection and etiological characteristics of respiratory tract infections were explored, the basic information, including the gender, age, pulmonary surgery history, anesthesia time, intubation approach, extubation time, laryngoscopes disinfection approach, preoperative use of antibiotics or hormones, diabetic mellitus, chronic respiratory system disease, and postoperative use of ventilators, was investigated;the univariate analysis and multivariate analysis were performed for the risk factors for the respiratory tract infections.RESULTS Totally 63 patients had the respiratory tract infection, with the infection rate 12.96%.A total of 64 strains of pathogens were isolated from sputum specimens, of which 31.25% （20 strains） were Klebsiella pneumoniae, 29.69% （19 strains） were Pseudomonas aeruginosa, 25.00% （16 strains） were Acinetobacter baumannii, and 14.06% （9 strains） were Staphylococcus aureus.The result of the multivariate logistic regression analysis indicated that the independent risk factors for the respiratory tract infections in the elderly patients after anesthesia included the no less than 65 years of age, history of smoking or pulmonary surgery, anesthesia time no less than 2.5 hours, oral endotracheal intubation, extubation time no less than 2 hours, common approach of disinfection of laryngoscopes, preoperative use of antibiotics or hormones, complication with diabetic mellitus or chronic respiratory diseases, and postoperative use of ventilators （P〈0.05）.CONCLUSION The independent risk factors for the respiratory tract infections in the elderly patients after the general anesthesia include the age, smoking, pulmonary surgery, anesthesia time, intubation approach, laryngoscopes disinfection approach, use of antibiotics, and complication with chronic respiratory diseases.It is proved that the K.pneumoniae infection is most common among the respiratory tract infection, and the effective prevention and control measures are put forward based on the etiological characteristics.