手术麻醉相关下呼吸道感染的危险因素及预防措施

Risk factors for surgical anesthesia-related lower respiratory tract infection and coping measures

目的分析手术麻醉相关下呼吸道感染的危险因素,制定应对措施,为预防下呼吸道感染提供参考依据。方法选取2014年10月-2016年12月医院收治的500例手术麻醉患者为研究对象,回顾性分析其术后发生下呼吸道感染情况,采集感染患者的痰液标本进行培养鉴定,分析病原菌的分布特征,同时对手术麻醉相关下呼吸道感染的危险因素进行单因素和多因素分析。结果 500例手术麻醉患者中,发生下呼吸道感染51例,感染率为10.2%;感染患者的基础疾病分布,以神经系统疾病所占比例最高,占35.29%;51份痰液标本中共分离出69株病原菌,其中革兰阴性菌39株占56.52%,革兰阳性菌27株占39.13%,其他菌2株占4.35%;单因素分析结果显示,麻醉方式、麻醉时间、麻醉机消毒方式、抗菌药物使用、麻醉机过滤器的使用与手术麻醉相关下呼吸道感染的发生具有相关性(P<0.05);多因素logistic回归分析结果显示,麻醉方式、麻醉时间、消毒方式、抗菌药物的使用及麻醉机过滤器的使用是引发下呼吸道感染的独立危险因素。结论手术麻醉相关下呼吸道感染的危险因素较多,临床上应对以上不利因素早期进行预防控制,以降低下呼吸道感染的发生,提高手术治疗效果。

OBJECTIVE To investigate the risk factors for surgical anesthesia-related lower respiratory tract infection and put forward the coping measures so as to provide guidance for prevention of the lower respiratory tract infection.METHODS A total of 500 patients who received surgical anesthesia in the hospital from Oct 2014 to Dec 2016 were recruited as the study objects.The incidence of postoperative lower respiratory tract infection was retrospectively analyzed, the sputum specimens that were obtained from the patients with infection were cultured, the isolated pathogens were identified, the distribution of the pathogens was observed, and the univariate analysis and multivariate analysis were performed for the risk factors for the surgical anesthesia-related lower respiratory tract infection.RESULTS Of the 500 patients who underwent the surgical anesthesia, 51 had the lower respiratory tract infection, with the infection rate 10.2%.Among the infection patients with underlying diseases, 35.29% had nervous system diseases.Totally 69 strains of pathogens were isolated from 51 sputum specimens, including 39 （56.5%） strains of gram-negative bacteria, 27 （39.13%） strains of gram-positive bacteria, and 2 （4.35%） strains of fungi.The result of the univariate analysis indicated that the incidence of the surgical anesthesia-related lower respiratory tract infection was associated with the anesthesia approach, time of anesthesia, disinfection approach of anesthesia machine, use of antibiotics, and use of filters of anesthesia machine （P〈0.05）.The result of the multivariate logistic regression analysis indicated that the anesthesia approach, time of anesthesia, disinfection approach, use of antibiotics, and use of filers of anesthesia machine were the independent risk factors for the lower respiratory tract infection.CONCLUSION There are a variety of risk factors for the surgical anesthesia-related lower respiratory tract infection.It is necessary for the hospital to prevention and control the risk factors in early stage so as to reduce the incidence of respiratory tract infection and improve the effect of surgical treatment.