气管内插管和喉罩麻醉对手术儿童下呼吸道感染的影响

发布时间：2018-02-20 23:33

本文关键词： 气管内插管喉罩麻醉儿童下呼吸道感染影响　出处：《中华医院感染学杂志》2017年17期 　论文类型：期刊论文

【摘要】：目的探究气管内插管和喉罩麻醉两种气道管理方式对手术儿童发生下呼吸道感染的影响。方法选取2014年1月-2016年1月于医院择期进行手术的106例患儿为研究对象,分析气管内插管和喉罩麻醉后感染情况;将患儿按照随机数表法进行分组,每组各53例;对照组患儿置入气管内插管,观察组患儿置入喉罩;术后3d比较两组患儿中咳嗽、发热、肺部闻及粗湿Up音发生情况;术后10min观察并统计两组患儿中恢复自主呼吸的患儿数量及比例,术后20min统计两组患儿中拔管患儿数量及比例;统计气管内插管和喉罩麻醉后下呼吸道感染发生情况;采集感染患儿临床样本进行病原菌培养及鉴定。结果术后3d对照组咳嗽5例(9.43%)、发热9例(16.98%)、肺部闻及粗湿Up音6例(11.32%);观察组咳嗽1例(1.89%)、发热3例(5.66%)、肺部闻及粗湿Up音2例(3.77%),两组比较差异有统计学意义(P0.05);10min后恢复自主呼吸患儿数量及比例为对照组45例(84.91%),观察组48例(90.57%);20min后拔管患儿数量及比例为对照组24例(45.29%)、观察组23例(43.40%),两组比较差异无统计学意义;106例患儿中共有23例发生下呼吸道感染,感染率为21.70%;其中对照组15例(28.30%),观察组8例(15.09%),两组比较差异有统计学意义(P0.05);共检出病原菌45株,其中革兰阴性菌34株占75.56%,革兰阳性菌7株占15.55%,感染病原菌以铜绿假单胞菌、肺炎克雷伯菌、鲍氏不动杆菌为主,分别占31.11%、20.00%、13.33%。结论气管内插管和喉罩麻醉两种气道管理方式均会引起一定的下呼吸道感染,且气管内插管引起的下呼吸道感染率高于喉罩。
[Abstract]:Objective to investigate the effect of endotracheal intubation and laryngeal mask anesthesia on lower respiratory tract infection in children undergoing operation. The infection after endotracheal intubation and laryngeal mask anesthesia was analyzed. The children were divided into three groups according to random number method: 53 cases in each group; 53 cases in the control group were placed in endotracheal intubation and larynx mask was placed in the observation group; 3 days after operation, cough was compared between the two groups. The number and proportion of spontaneous respiration in the two groups were observed and counted 10 minutes after operation, and 20 minutes after operation, the number and proportion of extubation in the two groups were counted. The incidence of lower respiratory tract infection after endotracheal intubation and laryngeal mask anesthesia was analyzed. Results three days after operation, 5 cases of cough, 9 cases of fever and 16. 98% of cough in the control group, 6 cases of the lung smell and crude wet up sound, 6 cases of the observation group, 1 case of cough 1.89%, 3 cases of fever 5.66%, the lung smell and coarse wet up, the observation group 1 case of cough, 3 cases of fever 5. 66%, the lung smell and the coarse wet up, the observation group 1 case of cough, 3 cases of fever 5.66%, the lung smell and coarse wet up. There were significant differences between the two groups in the number and proportion of children with spontaneous respiration in the control group (45 cases), in the observation group (48 cases) after 20 minutes, in the control group (24 cases), in the control group (24 cases), in the observation group (23 cases), in the control group (23 cases), in the comparison of the two groups. There were 23 cases of lower respiratory tract infection in 106 cases. The infection rate was 21.70 in the control group (15 cases) and the observation group (8 cases), the difference between the two groups was statistically significant (P 0.05). A total of 45 strains of pathogenic bacteria were detected, of which 34 strains were Gram-negative bacteria (34 strains), 7 strains were gram-positive bacteria (15.55%), and the pathogenic bacteria were Pseudomonas aeruginosa (Pseudomonas aeruginosa). Klebsiella pneumoniae and Acinetobacter baumannii accounted for 31.11% 20.00% 13.33% respectively. Conclusion endotracheal intubation and laryngeal mask anesthesia can cause lower respiratory tract infection, and the infection rate of lower respiratory tract caused by endotracheal intubation is higher than that caused by laryngeal mask.
【作者单位】：海口市妇幼保健院麻醉科;
【基金】：海南省自然科学基金资助项目(20158312)
【分类号】：R726.1

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