本文選題：全身麻醉 + 氣管插管��； 參考：《中華醫(yī)院感染學(xué)雜志》2017年04期

【摘要】：目的探討全身麻醉氣管插管對患者手術(shù)后呼吸道感染的影響,為臨床預(yù)防術(shù)后呼吸道感染提供參考依據(jù)。方法回顧性分析2014年1月-2016年6月在醫(yī)院行全身麻醉氣管插管的患者5 166例,統(tǒng)計患者呼吸道感染率,病原菌分布及主要病原菌的耐藥率;分析患者的性別、年齡、手術(shù)部位、麻醉通氣時間、術(shù)后延遲拔管、插管熟練度以及拔管指征完全,確定患者術(shù)后呼吸道感染相關(guān)因素。結(jié)果 5 166例患者中感染196例(3.8%);感染患者共培養(yǎng)出病原菌224株,其中單一感染患者168例,混合感染患者28例,感染病原菌以革蘭陰性菌為主165株占73.7%,革蘭陽性菌54株占24.1%,真菌5株占2.2%;革蘭陰性菌中銅綠假單胞菌對慶大霉素、頭孢吡肟、阿莫西林、諾氟沙星的耐藥率較高,對亞胺培南和美羅培南的耐藥率均為0;大腸埃希菌對慶大霉素、頭孢吡肟、諾氟沙星等耐藥率較高,對阿米卡星、亞胺培南和美羅培南的耐藥率較低;革蘭陽性菌中金黃色葡萄球菌對青霉素、阿莫西林、頭孢曲松和頭孢唑林等耐藥率較高,對芐卡西林和萬古霉素的耐藥率均為0,表皮葡萄球菌對青霉素、阿莫西林、頭孢曲松的耐藥率較高,對克林霉素、環(huán)丙沙星、芐卡西林和萬古霉素等耐藥率較低;不同年齡、手術(shù)部位、麻醉通氣時間、術(shù)后延遲拔管、插管熟練度以及拔管指征完全均對全身麻醉氣管插管患者術(shù)后呼吸道感染率有明顯影響。結(jié)論臨床上要對全身麻醉氣管插管患者呼吸道感染的危險因素進(jìn)行適當(dāng)干預(yù),降低感染率,對已經(jīng)發(fā)生呼吸道感染的患者,要結(jié)合病原菌藥敏試驗給予合理的抗菌藥物治療。
[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.
【作者單位】： 麗水市人民醫(yī)院麻醉科;麗水市中心醫(yī)院手術(shù)室;
【分類號】：R614.2

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