麻醉通气系统病原菌污染情况的研究

发布时间：2018-05-31 14:02

本文选题：麻醉机 + 全麻　；参考：《广西医科大学》2014年硕士论文

【摘要】：背景及目的：近年来,因全身麻醉各方面优点突出,气管内插管全麻在临床中的应用也逐渐增加,但术后肺部感染也随之增多。本次研究旨在了解麻醉机通气系统病原微生物定植特点,为临床减少麻醉相关院内感染提供新的干预途径。同时观察在层流净化环境下没有采取干预措施的麻醉机,全麻术后手术病人下呼吸道感染的情况。方法：选择全麻插管择期手术患者30例,分别于麻醉开始前、麻醉2h、麻醉4h(或麻醉结束)对麻醉机氧气出气口、麻醉机进气口、麻醉机储气囊及一次性螺纹管Y型接口,术中易被污染的4个区域进行细菌学采样,随后接种至血液培养基中培养、分离纯化后再用微生物生化鉴定系统进行鉴定,随后进行统计分析。术后对患者进行随访。资料进行整理后,对数据进行统计学分析。结果： (1)麻醉机通气系统培养出的定植菌均为条件致病菌,革兰阳性菌占45.37%,主要为表皮葡萄球菌、棒状杆菌等；革兰阴性菌占15.74%,主要为黄杆菌属；真菌占38.89%,主要是酵母样真菌和类酵母样真菌。 (2)麻醉通气系统各部位定植菌阳性率不同,氧气出气口、麻醉机进气口、储气囊口及Y型连接口阳性率分别为11.8%、78.9%、3.9%和5.3%,差异有统计学意义,(P0.05)。定植菌主要存在于麻醉机进气口。 (3)麻醉通气系统各个部位定植菌阳性率在T0、T1、T2时段分别为42.1%、27.6%、30.3%,差异无统计学意义(P0.05)。 (4)术后患者下呼吸道感染率为0%。结论： 1.本研究表明我院麻醉机通气系统培养出的定植菌均为条件致病菌,主要定植于麻醉机进气口。 2.机械通气时间在4h内,定植菌在麻醉通气系统各个部位的定植数量不随着时间的延长而增多。 3.我院层流手术间里的麻醉机未采取干预,没有增加引起下呼吸感染相关并发症的几率。
[Abstract]:Background and purpose: In recent years, because of the advantages of general anesthesia, the application of endotracheal intubation general anesthesia has gradually increased, but the postoperative pulmonary infection has also increased. The purpose of this study was to understand the characteristics of pathogenic microorganism colonization in anesthetic ventilation system and to provide a new approach for clinical intervention to reduce nosocomial infection related to anesthesia. At the same time, we observed the lower respiratory tract infection of the patients after general anesthesia without intervention in laminar flow purification environment. Methods: Thirty patients undergoing elective operation of general anesthesia intubation were selected. Before anesthesia began, 2 hours after anesthesia, 4 hours after anesthesia (or the end of anesthesia), the oxygen outlet of anesthetic machine, the air inlet of anesthetic machine, the air bag of anaesthesia machine and the Y type interface of disposable threaded tube were used. Bacteriological samples were collected from 4 areas easily contaminated during the operation, then inoculated into blood culture medium, then isolated and purified, then identified by microbiological biochemical identification system, and then analyzed statistically. The patients were followed up after operation. After the data were sorted out, the data were analyzed statistically. Results: 1) the colonized bacteria cultured in the anesthetic ventilation system were all conditioned pathogens, Gram-positive bacteria accounted for 45.37, mainly Staphylococcus epidermidis and Corynebacterium, Gram-negative bacteria accounted for 15.74%, mainly xanthobacterium; Fungi accounted for 38.89, mainly yeast-like fungi and yeast-like fungi. (2) the positive rates of colonization bacteria in different parts of anesthetic ventilation system were different. The positive rates of oxygen outlet, air inlet of anesthetic machine, air bag port and Y-type connection port were 11.889% and 5.3%, respectively. The difference was statistically significant (P 0.05). The colonization bacteria mainly exist in the air inlet of anesthetic machine. (3) the positive rate of colonized bacteria in different parts of anesthesia ventilation system was 42.1 / 27.6and 30.3in T _ 0 / T _ 1 / T _ 2, respectively. The difference was not statistically significant (P 0.05). The infection rate of lower respiratory tract was 0%. Conclusion: 1. The results showed that the colonized bacteria cultured in the anesthetic ventilation system were conditioned pathogens and were mainly located in the air intake of anesthetic machine. 2. Within 4 hours of mechanical ventilation, the number of colonized bacteria in all parts of the anesthetic ventilation system did not increase with the extension of time. 3. No intervention was taken by the anesthetic machine in the laminar flow operation in our hospital, and the incidence of complications associated with lower respiratory infection was not increased.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614

【参考文献】