老年患者全身麻醉后呼吸道感染的病原菌特点及危险因素分析

发布时间：2018-09-03 12:37

【摘要】：目的研究老年患者在全身麻醉术后呼吸道感染的发病率、病原学特点及危险因素,为积极预防提供参考。方法选择2014年2月-2016年12月在医院行全身麻醉后的486例老年患者,回顾性分析临床资料,探究呼吸道感染率及病原学特点,调查患者性别、年龄、吸烟史、肺部手术史、麻醉时间、插管途径、拔管时间、喉镜消毒方式、术前抗菌药物或激素使用、糖尿病、慢性呼吸系统疾病及术后使用呼吸机等基本情况,对呼吸道感染的危险因素进行单因素及多因素分析。结果呼吸道感染患者63例,感染率12.96%,痰培养检出病原菌64株,主要为肺炎克雷伯菌20株占31.25%、铜绿假单胞菌19株占29.69%、鲍氏不动杆菌16株占25.00%,金黄色葡萄球菌9株占14.06%;多因素logistic回归分析结果显示,年龄≥65岁、有吸烟史或肺部手术史、麻醉时间≥2.5h、经口气管插管、拔管时间≥2h、普通喉镜消毒方式、术前使用抗菌药物或激素、有糖尿病或慢性呼吸系统疾病、术后使用呼吸机等是老年患者全身麻醉后呼吸道感染的独立危险因素(P0.05)。结论年龄、吸烟、肺部手术、麻醉时间、插管方式、喉镜消毒方式、使用呼吸机、使用抗菌药物以及合并慢性呼吸系统疾病等为老年患者全麻后呼吸道感染的独立危险因素,并证实了以肺炎克雷伯菌感染多见的病原学特点,由此形成有效的预防控制感染措施。
[Abstract]:Objective to study the incidence, etiological characteristics and risk factors of respiratory tract infection in elderly patients after general anesthesia. Methods A total of 486 elderly patients undergoing general anesthesia in hospital from February 2014 to December 2016 were selected. The clinical data were retrospectively analyzed, the respiratory tract infection rate and etiological characteristics were investigated, gender, age, smoking history, history of lung surgery were investigated. Anesthesia time, intubation pathway, extubation time, laryngoscope disinfection, preoperative use of antibiotics or hormones, diabetes mellitus, chronic respiratory diseases and postoperative use of respirators, etc. The risk factors of respiratory tract infection were analyzed by univariate and multivariate analysis. Results there were 63 cases of respiratory tract infection, the infection rate was 12.96%, 64 strains of pathogenic bacteria were detected in sputum culture. Twenty strains of Klebsiella pneumoniae accounted for 31.25%, 19 strains of Pseudomonas aeruginosa accounted for 29.69%, 16 strains of Acinetobacter baumannii accounted for 25.00% and 9 strains of Staphylococcus aureus accounted for 14.06%. Multivariate logistic regression analysis showed that the age of 鈮，

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