老年患者全麻插管后下呼吸道感染的病原菌及相关因素与抗感染分析

Pathogens,risk factors and anti-infection of lower respiratory tract infections after general anesthesia intubation in elderly patients

目的探究老年患者全麻插管后下呼吸道感染的病原菌及危险因素与抗感染分析。方法选择2013年2月-2016年9月于医院行全麻气管插管手术的老年患者428例为研究对象,对患者发生下呼吸道感染的相关因素进行观察和分析;根据下呼吸道感染发生时间将感染患者分为序贯组35例和对照组32例,对照组给予头孢曲松进行抗感染治疗,序贯组给予头孢曲松和头孢克肟进行序贯抗感染治疗,对两组患者的抗感染疗效进行分析;对其痰液进行细菌培养,分析其病原菌构成。结果 428例行全麻插管的老年患者中有67例出现下呼吸道感染,感染发生率为15.65%;感染患者的痰液样本中共分离出81株病原菌,以革兰阴性菌为主,共65株占80.25%;序贯组抗感染的总有效率和细菌清除率分别为91.43%、91.43%,均高于对照组的78.13%、71.88%(P<0.05);且序贯组患者的退热时间、咳嗽缓解时间、咳痰缓解时间及肺啰音消失时间均低于对照组(P<0.05);序贯组的不良反应发生率为5.71%,低于对照组的25.00%(P<0.05)。结论针对相关因素进行目标性、预见性干预和治疗,能有效降低相关感染情况的发生,应用抗菌药物进行序贯治疗能够获得较好的临床疗效,且临床用药安全可靠。

OBJECTIVE To investigate the pathogens,risk factors and anti-infection of lower respiratory tract infections after general anesthesia intubation in elderly patients.METHODS A total of 428 cases of elderly patients with general anesthesia tracheal intubation in our hospital from Feb.2013 to Sep.2016 were selected as the research objects.The risk factors of lower respiratory tract infections were observed and analyzed.The infected patients were divided into sequential group（35 cases）and control group（32 cases）according to the time of lower respiratory tract infections.The patients of control group were only treated with ceftriaxone for anti-infection treatment,and the patients of sequential group were treated with ceftriaxone and cefixime for sequential anti infection treatment.The anti-infection effect of the two groups were analyzed.The composition of pathogenic bacteria was analyzed by sputum bacterial culture.RESULTS In 428 elder patients with general anesthesia intubation,there were 67 cases had lower respiratory tract infections,and the infection rate was 15.65%.Totally 81 strains of pathogenic bacteria were isolated from sputum samples of infected patients,which were mainly 65 strains of gram-negative bacteria,accounting for 80.25%.In the anti infection treatment,the total effective rate of anti-infection and bacterial clearance rate of the sequential group were 91.43% and 91.43%,respectively,which were significantly higher than78.13% and 71.88% of control group（P〈0.05）,and the fever reducing time,cough remission time,sputum remission time and pulmonary rales remission time of sequential group were significantly lower than those of control group（P〈0.05）.The incidence of adverse reactions in sequential group was 5.71%,which was significantly lower than 25.00%in control group（P〈0.05）.CONCLUSIONAiming at the related factors,the targeted and predictive intervention and treatment can effectively reduce the incidence of infections.In the anti-infection treatment,use antimicrobial agents for sequential treatment can get better clinical efficacy,and the clinical medication is safe and reliable.