全身麻醉气管插管患儿术后下呼吸道感染的发生情况及病原菌特点

The incidence and pathogenic bacteria characteristics of lower respiratory tract infection in children after endotracheal intubation under general anesthesia

目的对小儿全身麻醉气管内插管手术后下呼吸道感染的危险因素及病原菌分布状况进行分析,旨在为临床提供一定的参考意见。方法选取2016年3月-2019年3月全身麻醉气管内插管下手术的患儿988例,对患儿下呼吸道感染的发生情况、病原菌分布及影响因素进行统计分析。结果 988例气管内插管全身麻醉的患儿中有42例术后发生下呼吸道感染,下呼吸道感染的发生率为4. 25%,42例发生下呼吸道感染患儿分离培养出62株病原菌,革兰阴性菌有42株,占总菌株数的67. 74%;Logistic回归分析结果表明,年龄<6岁、合并上呼吸道感染、手术时间≥4 h、插管不熟练和插管≥2次才成功是导致全身麻醉下气管插管患儿术后下呼吸道感染发生的危险因素(OR> 1,P <0. 05),而插管前口腔准备则是避免全身麻醉下气管插管患儿术后下呼吸道感染发生的保护性因素(OR <1,P <0. 05)。结论下呼吸道感染中最主要的病原菌为革兰阴性菌,其与患儿的年龄、手术时间、医师插管熟练程度、是否合并上呼道感染以及是否在插管前清洁口腔关系密切。

Objective To analyze the risk factors and pathogenic bacteria distribution of lower respiratory tract infection in children after endotracheal intubation under general anesthesia,so as to provide some reference for clinical practice. Methods 988 children who underwent endotracheal intubation under general anesthesia from March 2016 to March 2019 were the object. The incidence of lower respiratory tract infection,the distribution of pathogens and influencing factors in children were statistically analyzed. Results Of 988 children with endotracheal intubation under general anesthesia,42 cases had lower respiratory tract infection after operation. The incidence of lower respiratory tract infection was 4. 25%. 62 strains of pathogenic bacteria were isolated and cultured from 42 children with lower respiratory tract infections. There were 42 strains of Gram-negative bacteria,accounting for 67. 74% of the total number of strains. Logistic regression analysis showed that age < 6 years old,combination with upper respiratory tract infection,operation time ≥4 h,unskilled intubation and intubation ≥2 times before success were the risk factors of lower respiratory tract infection in children with endotracheal intubation under general anesthesia( OR > 1,P < 0. 05),and oral preparation before intubation was the protective factors for avoiding the occurrence of lower respiratory tract infection in children with endotracheal intubation under general anesthesia( OR <1,P < 0. 05). Conclusion Gram-negative bacteria are the most common pathogens of lower respiratory tract infection,and they are closely related to children’s age,operation time,doctors’ intubation proficiency,whether or not combined with upper respiratory tract infection and oral cleaning before intubation.