全身麻醉术后下呼吸道感染相关影响因素分析

Influencing factors for lower respiratory tract infections after general anesthesia

目的分析全身麻醉患者术后发生医院下呼吸道感染的相关因素,为降低患者术后下呼吸道感染提供临床依据。方法回顾性分析2015年5月-2016年5月医院接受气管插管全身麻醉手术治疗的439例患者的临床资料,分析下呼吸道感染患者病原菌检出情况,采用单因素以及多因素Logistic回归分析患者术后发生下呼吸道感染的相关影响因素。结果 439例接受气管插管全身麻醉手术治疗患者,35例术后发生下呼吸道感染,感染率为7.97%;共分离病原菌42株,其中铜绿假单胞菌以及鲍氏不动杆菌构成比最高,分别为35.71%、33.33%;单因素及多因素Logistic回归分析结果显示,麻醉时间、年龄、肺部手术、人工鼻以及吸烟史为影响全身麻醉术后下呼吸道感染的影响因素。结论麻醉时间、年龄、肺部手术以及吸烟史是全身麻醉术后医院下呼吸道感染的独立影响因素,使用人工鼻是患者术后医院下呼吸道感染的保护因素。采取针对性措施进行感染防护,如尽早戒烟、尽可能缩短手术时间以及麻醉通气时间,从而减少气管插管全身麻醉患者术后下呼吸道感染率。

OBJECTIVE To investigate the related factors for postoperative lower respiratory tract infections in the general anesthesia patients so as to provide guidance for clinical treatment of the patients with postoperative lower respiratory tract infections.METHODS The clinical data of 439 patients who received surgical procedures under general anesthesia from May 2015 to May 2016 were retrospectively analyzed,the distribution of pathogens isolated from the patients with lower respiratory tract infection were observed.Univariate analysis and multivariate logistic regression analysis were performed for the influencing factors for the postoperative lower respiratory tract infections.RESULTS Of the 439 patients who received surgical procedures under general anesthesia,35 had postoperative lower respiratory tract infection,with the infection rate 7.97%.A total of 42 strains of pathogens were isolated,Pseudomonas aeruginosa and Acinetobacter baumannii were the predominant species,accounting for 35.71% and 33.33%,respectively.The results of univariate analysis and multivariate logistic regression analysis showed that the anesthesia time,age,pulmonary surgery,artificial nose and smoking history were the influencing factors for the postoperative lower respiratory tract infections.CONCLUSIONThe anesthesia time,age,pulmonary surgery and smoking history are the independent influencing factors for the postoperative lower respiratory tract infections in the general anesthesia patients,the use of artificial nose was the protective factor for the postoperative lower respiratory tract infections.It is necessary to take targeted prevention measures such as quitting smoke and shortening operation and anesthesia ventilation time as much as possible so as to reduce the incidence of postoperative lower respiratory tract infections as much as possible.