不同麻醉方式对老年骨折手术患者呼吸道感染的影响

Effect of different forms of anesthesia on respiratory tract infections in elderly patients undergoing surgery for a fracture

目的探讨不同麻醉方式对老年骨折手术患者呼吸道感染的影响。方法2016年1月至2020年1月在本院行骨折手术治疗的老年患者156例,其中全身麻醉组66例,腰-硬联合麻醉组90例,比较两组患者呼吸道感染发生率、麻醉方式和呼吸道感染的关联性,以及呼吸道感染病原菌分布及耐药性情况。结果腰-硬联合麻醉组患者呼吸道感染发生率为7.78%,与全身麻醉组发生率19.70%比较差异有统计学意义(χ^(2)=4.840,P<0.05)。腰-硬联合麻醉是老年骨折手术患者发生呼吸道感染的保护因素(OR=0.751,P<0.05)。腰-硬联合麻醉组7例呼吸道感染患者共检出12株病原菌,其中革兰阴性菌8株(66.67%),革兰阳性菌4株(33.33%);全身麻醉组13例呼吸道感染患者共检出20株病原菌,其中革兰阴性菌13株(65.00%),革兰阳性菌7株(35.00%)。两组患者呼吸道感染病原菌分布差异无统计学意义(χ^(2)=0.009,P>0.05)。腰-硬联合麻醉组呼吸道感染患者感染病原菌对青霉素/头孢呋辛的耐药率为8.33%,与全身麻醉组耐药率40.00%比较差异有统计学意义(χ^(2)=4.220,P<0.05);腰-硬联合麻醉组、全身麻醉组患者感染的病原菌对美罗培南耐药率分别为0和5.00%,差异无统计学意义(P>0.05)。结论腰-硬联合麻醉可显著降低老年骨折手术患者呼吸道感染发生率,感染病原菌对青霉素/头孢呋辛有耐药性,对美罗培南较敏感,可供参考。

Objective To investigate the effect of different forms of anesthesia on respiratory tract infections in elderly patients undergoing surgery for a fracture.Methods One hundred and fifty-six elderly patients underwent surgery for a fracture at this Hospital from January 2016 to January 2020.Sixty-six patients received general anesthesia and 90 received spinal and epidural anesthesia.The incidence of a respiratory tract infection,form of anesthesia,the correlation between anesthesia and development of a respiratory tract infection,and the distribution and drug resistance of pathogens causing a respiratory tract infection were compared between the two groups.Results The incidence of a respiratory tract infection in patients receiving spinal and epidural anesthesia was 7.78%,which was significantly higher than that in patients receiving general anesthesia(19.70%)(χ^(2)=4.840,P<0.05).Spinal and epidural anesthesia protected against development of a respiratory tract infection in elderly patients undergoing surgery for a fracture(OR=0.751,P<0.05).Twelve strains of pathogens were detected in 7 patients who received spinal and epidural anesthesia and who developed a respiratory tract infection,including 8 strains of Gram-negative bacteria(66.67%)and 4 strains of Gram-positive bacteria(33.33%).Twenty pathogens were detected in 13 patients who received general anesthesia and who developed a respiratory tract infection,including 13 strains of Gram-negative bacteria(65.00%)and 7 strains of Gram-positive bacteria(35.00%).There were no significant differences in the distribution of pathogens causing a respiratory tract infection between the two groups(χ^(2)=0.009,P>0.05).The resistance of pathogenic bacteria to penicillin/cefuroxime in patients receiving spinal and epidural anesthesia was 8.33%,which was significantly higher than that in patients receiving general anesthesia(40.00%)(χ^(2)=4.220,P<0.05).The resistance of pathogens causing a respiratory infection to meropenem was 0%(0/12)in patients receiving spinal and epidural anesthesia and 5.00%(1/20)in patients receiving general anesthesia.Fisher’s exact test revealed no significant differences between the two(P=0.625).Conclusion Spinal and epidural anesthesia can significantly reduce the incidence of a respiratory tract infection in elderly patients undergoing surgery for a fracture.The pathogenic bacteria causing such an infection have a certain level of resistance to penicillin/cefuroxime but are sensitive to meropenem.This finding can serve as a clinical reference.