口腔颌面手术全身麻醉术后下呼吸道感染的危险因素探讨

Risk factors of lower respiratory tract infection after general anesthesia for oral and maxillofacial surgery

目的主要对口腔颌面手术患者全身麻醉(全麻)术后下呼吸道感染的主要危险因素展开分析,了解患者患者术后下呼吸道感染发生的相关原因。方法选择2014年12月至2018年12月该院收治的口腔颌面手术患者402例作为研究对象,详细记录患者个人的基本信息、病史等,记录术后出现并发症下呼吸道感染患者的例数,分析患者出现下呼吸道感染的危险因素。结果402例患者中2例患者因为手术后2d出院无法进行追踪了解患者下呼吸道感染,因此将其剔除。400例患者均完整进行随访,其中发生下呼吸道感染19例,发生率为4.75%。患者术前并未接受口腔护理、急症手术、手术时间超过3h、感染性疾病手术、既往慢性呼吸系统感染、吸烟史、高龄等因素是患者术后出现下呼吸道感染的主要危险因素,差异均有统计学意义(P<0.05)。结论气管插管全麻应用于口腔颌面手术患者,若患者术前并未接受口腔护理、急症手术、手术时间超过3h、感染性疾病手术、既往慢性呼吸系统感染、吸烟史、高龄,则术后下呼吸道感染的机率会明显提升。患者在术后需要加强多方面的措施干预,以降低患者全麻术后出现下呼吸道感染的可能。

Objective To analyze the main risk factors of lower respiratory tract infection after general anesthesia in patients undergoing oral and maxillofacial surgery,and to understand the related causes of lower respiratory tract infection after surgery. Methods 402 patients with oral and maxillofacial surgery treated in our hospital from December 2014 to December 2018 were included in the study. The basic information and medical history of the patients were recorded in detail. The number of patients with lower respiratory tract infection complications after operation was recorded,and the risk factors of lower respiratory tract infection were analyzed. Results Among 402 patients,2 patients were excluded because they could not follow up the lower respiratory tract infection 2 days after operation. All the 400 patients were followed up completely,19 of them had lower respiratory tract infection,the incidence was 4.75%. In multivariate analysis,the main risk factors for lower respiratory tract infection after operation were not receiving oral care before operation,emergency operation,the operation over three hours,operation for infectious diseases,past chronic respiratory infection,smoking history and old age( P <0.05). Conclusion General anesthesia with tracheal intubation applied to patients undergoing oral and maxillofacial surgery can significantly increase the incidence of lower respiratory tract infection if the patients do not receive oral care,emergency surgery,the operation over three hours,infectious disease surgery,past chronic respiratory infection,smoking history and old age. In order to reduce the possibility of lower respiratory tract infection after general anesthesia,patients need to strengthen various interventions.