下肢骨折卧床老年患者气管插管全麻术后肺部感染的致病菌与危险因素

Pathogens and risk factors of pulmonary infection in elderly patients lying in bed with lower limb fracture after endotracheal intubation under general anesthesia

目的探索下肢骨折卧床老年患者气管插管全麻手术后肺部感染的致病菌与危险因素。方法选取某院全身麻醉下手术治疗的下肢骨折卧床老年患者为研究对象,收集患者术后肺部感染的发生及致病菌情况,对可能影响患者发生肺部感染的因素分别进行单因素与多因素分析。结果497例下肢骨折卧床气管插管全麻下手术的老年患者,有54例(10.87%)在术后发生了肺部感染,共分离出83株致病菌,其中革兰阳性菌、革兰阴性菌和真菌分别有19株、59株和5株。logistic分析结果提示年龄≥75岁、术后卧床时间≥7 d、麻醉时间≥120 min、合并慢阻肺及术后使用呼吸机是患者发生肺部感染的危险因素(OR>1,P<0.05),而气管插管前口腔消毒则是避免患者发生肺部感染的保护性因素(OR<1,P<0.05)。结论下肢骨折卧床老年患者气管插管全麻手术后肺部感染的发生率较高,革兰阴性菌为其主要致病菌,其与多种因素有关,应引起关注。

Objective To explore the pathogens and risk factors of pulmonary infection in elderly patients lying in bed with lower limb fracture after endotracheal intubation and general anesthesia.Methods The elderly patients lying in bed with lower limb fracture who had surgical treatment under general anesthesia in a hospital were selected as the research objects.The incidence of postoperative pulmonary infection and pathogens were collected,and the factors that might affect the occurrence of pulmonary infection were analyzed by univariate and multivariate analysis.Results Of the 497 elderly patients lying in bed with lower limb fractures who underwent operation after endotracheal intubation under general anesthesia,54(10.87%)had pulmonary infection after operation.A total of 83 strains of pathogenic bacteria were isolated,including 19 strains of gram-positive bacteria,59 strains of gram-negative bacteria and 5 strains of fungi,respectively.The logistic analysis showed that age≥75 years old,postoperative bed rest time≥7 d,anesthesia time≥120 min,combined chronic obstructive pulmonary disease and postoperative use of ventilator were the risk factors for pulmonary infection in patients(OR>1,P<0.05),while oral disinfection before endotracheal intubation was the protective factor to avoid pulmonary infection in patients(OR<1,P<0.05).Conclusion The incidence of pulmonary infection in elderly patients lying in bed with lower limb fracture after endotracheal intubation under general anesthesia is high.Gram negative bacteria are the main pathogenic bacteria,which are related to many factors and should be paid attention to.