气管插管全麻术后下呼吸道感染的麻醉相关因素分析

Anesthesia-associated factors of lower respiratory tract jnfection in general anesthesia with tracheal intubation

目的通过回顾性调查分析,找出气管插管全麻病人术后并发下呼吸道感染的麻醉相关因素。方法回顾性调查某院以往5年内气管插管全麻术后无明显混淆因子干扰并发下呼吸道感染的全部病例,应用病例对照研究法分析插管途径、盲探插管、插管熟练度、插管深度、拔管指征、拔管延迟等因素引起下呼吸道感染的比值比(OR)及其95％可信限。结果插管过深(OR=2.15),插管不熟练(OR=2.02),拔管指征不完全(OR=2.18),拔管延迟超过>3小时(OR=3.4),经检验,统计学有显著意义;而拔管延迟<3 h、经口腔插管、盲探插管等的OR分别为1.10、1.53、1.86,经检验,统计学无显著意义。结论气管插管全麻中,插管不熟练、插管过深、术后拔管延迟>3小时以上、拔管指征不完全等都是术后并发下呼吸道感染的诱发因素。

Objective To evaluate anesthesia-associated factors of lower respiratory tract infection in patients with tracheal intubation general anesthesia. Methods By case-control study, all the patients in a hospital with lower respiratory tract infection after tracheal intubation general anesthesia in the past 5 years were investigated retrospectively, interfering factors were excluded, the odds ratio (OR) and 95% confidence interval of related factors of the way of intubation, blind intubation the skill of practitioner, depth of intubation, indication of decannulation and delayed decannulation were calculated and analysed, the relationship of them to lower respiratory tract infection were evaluated. Results The value of OR of over-deep intubation,unpracticed intubation, improper indication of decannulation,delayed decannulation >3 hours was 2.15,2.02,2.18,3.4 respectively, there was great statistical significance; the value of OR of delayed decannulation <3 hours ,peroral intubation, blind intubation was 1.10,1.53,1.86 respectively, there was no statistical significance. Conclusion It is suggested that unskilled performance, over-deep intubation, delayed decannulation >3 hours and improper indication of decannulation were risk factors for lower respiratory tract infection in patients with tracheal intubation general anesthesia.