全身麻醉气管插管对患者手术后呼吸道感染的影响

发布时间：2018-04-23 01:16

本文选题：全身麻醉 + 气管插管　；参考：《中华医院感染学杂志》2017年04期

【摘要】：目的探讨全身麻醉气管插管对患者手术后呼吸道感染的影响,为临床预防术后呼吸道感染提供参考依据。方法回顾性分析2014年1月-2016年6月在医院行全身麻醉气管插管的患者5 166例,统计患者呼吸道感染率,病原菌分布及主要病原菌的耐药率;分析患者的性别、年龄、手术部位、麻醉通气时间、术后延迟拔管、插管熟练度以及拔管指征完全,确定患者术后呼吸道感染相关因素。结果 5 166例患者中感染196例(3.8%);感染患者共培养出病原菌224株,其中单一感染患者168例,混合感染患者28例,感染病原菌以革兰阴性菌为主165株占73.7%,革兰阳性菌54株占24.1%,真菌5株占2.2%;革兰阴性菌中铜绿假单胞菌对庆大霉素、头孢吡肟、阿莫西林、诺氟沙星的耐药率较高,对亚胺培南和美罗培南的耐药率均为0;大肠埃希菌对庆大霉素、头孢吡肟、诺氟沙星等耐药率较高,对阿米卡星、亚胺培南和美罗培南的耐药率较低;革兰阳性菌中金黄色葡萄球菌对青霉素、阿莫西林、头孢曲松和头孢唑林等耐药率较高,对苄卡西林和万古霉素的耐药率均为0,表皮葡萄球菌对青霉素、阿莫西林、头孢曲松的耐药率较高,对克林霉素、环丙沙星、苄卡西林和万古霉素等耐药率较低;不同年龄、手术部位、麻醉通气时间、术后延迟拔管、插管熟练度以及拔管指征完全均对全身麻醉气管插管患者术后呼吸道感染率有明显影响。结论临床上要对全身麻醉气管插管患者呼吸道感染的危险因素进行适当干预,降低感染率,对已经发生呼吸道感染的患者,要结合病原菌药敏试验给予合理的抗菌药物治疗。
[Abstract]:Objective to investigate the effect of general anesthesia tracheal intubation on postoperative respiratory tract infection in patients, and to provide reference for clinical prevention of postoperative respiratory tract infection. Methods from January 2014 to June 2016, 5 166 patients undergoing general anesthesia tracheal intubation in hospital were retrospectively analyzed. The respiratory tract infection rate, the distribution of pathogenic bacteria and the drug resistance rate of the main pathogens were analyzed, and the sex, age, site of operation of the patients were analyzed. Anesthesia ventilation time, postoperative delayed extubation, intubation proficiency and extubation indication were complete to determine the related factors of postoperative respiratory tract infection. Results among 5 166 patients, 196 cases were infected, 224 strains of pathogenic bacteria were cultured, 168 cases were single infection, 28 cases were mixed infection. Among the gram-negative bacteria, 165 strains were Gram-negative bacteria, 54 strains were Gram-positive bacteria, and 5 strains were fungi. The resistance rate of Pseudomonas aeruginosa to gentamicin, cefepime, amoxicillin and norfloxacin was higher than that of gram-negative bacteria, and the resistance rate of Pseudomonas aeruginosa to gentamicin, cefepime, amoxicillin and norfloxacin was higher. The resistance rates of Escherichia coli to gentamicin, cefepime and norfloxacin were higher than those to amikacin, imipenem and meropenem. Among Gram-positive bacteria, Staphylococcus aureus had higher resistance to penicillin, amoxicillin, ceftriaxone and cefazolin. The resistance rates of Staphylococcus epidermidis to penicillin, amoxicillin and vancomycin were 0. The drug resistance of ceftriaxone was higher than that of clindamycin, ciprofloxacin, benkassim and vancomycin. Intubation proficiency and extubation indication all had significant influence on postoperative respiratory tract infection rate in patients with general anesthesia tracheal intubation. Conclusion the risk factors of respiratory tract infection in patients with general anesthesia and tracheal intubation should be properly intervened in order to reduce the infection rate. The patients who have already developed respiratory tract infection should be treated with reasonable antimicrobial agents in combination with pathogen susceptibility test.
【作者单位】：丽水市人民医院麻醉科;丽水市中心医院手术室;
【分类号】：R614.2

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