老年全麻手术患者围术期出现麻醉相关感染危险因素及氧化应激水平变化

Analysis of risk factors of anesthesia⁃related infection and changes of oxidative stress level in elderly patients undergoing general anesthesia during perioperative period

目的分析老年全麻手术患者围术期出现麻醉相关感染的危险因素,探讨氧化应激指标对其感染的预测价值。方法选择蒙城县第一人民医院2020年7月-2022年12月收治的全麻下行手术术后发生围术期感染患者90例研究对象作为感染组;另外选择同年龄段、知情同意且未发生围术期感染的患者218例作为未感染组。入组研究对象的病历资料由专人登记、记录一般资料,再对导致感染的危险因素进行分析;两组术前、感染组在出现发热症状前1 d、未感染组在手术结束后第2天分别检测血清超氧化物歧化酶(SOD)、丙二醛(MDA)、过氧化氢酶(CAT)水平,并采用受试者工作特征(ROC)曲线分析上述指标对老年全麻手术患者围术期出现麻醉相关感染的预测价值。结果感染组与未感染组患者气管通气道、深静脉动脉穿刺、合并糖尿病、钠石灰更换次数差异均有统计学意义(χ^(2)=15.758、4.250、6.122、11.590,P均<0.05)。多因素分析结果显示,老年全麻手术患者围术期出现麻醉相关感染的影响因素为气管通气道为气管导管、进行深静脉动脉穿刺、合并糖尿病、钠石灰更换次数<1次/d(P均<0.05)。两组患者术前SOD、MDA、CAT水平差异无统计学意义(P均>0.05);术后感染组SOD、CAT水平均低于未感染组,MDA水平高于未感染组,差异均有统计学意义(t=11.748、9.346、5.234,P均<0.001)。ROC曲线分析结果显示,血清SOD(AUC=0.866,95%CI:0.825~0.907,临界值为22.37 U/L)、MDA(AUC=0.666,95%CI:0.597~0.736,临界值为54.29 U/L)、CAT(AUC=0.811,95%CI:0.763~0.860,临界值为34.79 U/L)对老年全麻手术患者围术期出现麻醉相关感染均有一定诊断价值。结论老年全麻手术患者围术期出现麻醉相关感染危险因素相对较多,临床应针对原因采取预防措施。

Objective To investigate the risk factors of anesthesia related infection in elderly patients undergoing general anesthesia during perioperative period and the predictive value of oxidative stress index.Methods A total of 90 patients with perioperative infection after surgery under general anesthesia treated in the First People's Hospital of Mengcheng from July 2020 to December 2022 were selected as the infection group.218 patients in the same age group with informed consent and no perioperative infection were selected as the non⁃infected group.The medical records of the enrolled subjects were registered and recorded by specially⁃assigned persons,and then the risk factors of infection were analyzed.Serum levels of superoxide dismutase(SOD),malondialdehyde(MDA)and catalase(CAT)in the two groups were detected before surgery,1 day before fever appeared in the infected group,and 2 days after surgery in the uninfected group.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of the above indexes for perioperative anesthesia⁃related infections in elderly patients undergoing general anesthesia.Results There was a statistical difference in the number of cases of trachea,deep vein artery puncture,diabetes and sodium lime replacement between infected and uninfected patients(χ^(2)=15.758,4.250,6.122,11.590;all P<0.05).The results of multifactor analysis showed that the influencing factors of anesthesia related infection in elderly patients undergoing general anesthesia surgery during the perioperative period were that the trachea was endotracheal tube,deep vein artery puncture was performed,diabetes was complicated,and the number of sodium lime replacement was less than 1 time/day(all P<0.05).There was no significant difference in preoperative SOD,MDA and CAT levels between the two groups(P>0.05);postoperative SOD and CAT levels in the infected group were lower than those in the uninfected group(t=11.748,9.346;all P<0.001),while MDA levels were higher than those in the uninfected group(t=5.234,P<0.001).ROC curve analysis results showed that serum SOD(AUC=0.866,95%CI:0.825-0.907,critical value:22.37 U/L),MDA(AUC=0.666,95%CI:0.597-0.736,critical value:54.29 U/L),CAT(AUC=0.811,95%CI:0.763-0.860,critical value:34.79 U/L)had a certain predictive value for perioperative anesthesia⁃related infection in elderly patients undergoing general anesthesia.Conclusion There were relatively more risk factors of anesthesia⁃related infection in elderly patients undergoing general anesthesia during perioperative period,and the changes of serum SOD,MDA and CAT levels had certain predictive value for their infection.