發(fā)布時(shí)間：2018-05-31 14:02

  本文選題：麻醉機(jī) + 全麻　； 參考：《廣西醫(yī)科大學(xué)》2014年碩士論文

【摘要】：背景及目的： 近年來,因全身麻醉各方面優(yōu)點(diǎn)突出,氣管內(nèi)插管全麻在臨床中的應(yīng)用也逐漸增加,但術(shù)后肺部感染也隨之增多。本次研究旨在了解麻醉機(jī)通氣系統(tǒng)病原微生物定植特點(diǎn),為臨床減少麻醉相關(guān)院內(nèi)感染提供新的干預(yù)途徑。同時(shí)觀察在層流凈化環(huán)境下沒有采取干預(yù)措施的麻醉機(jī),全麻術(shù)后手術(shù)病人下呼吸道感染的情況。 方法： 選擇全麻插管擇期手術(shù)患者30例,分別于麻醉開始前、麻醉2h、麻醉4h(或麻醉結(jié)束)對麻醉機(jī)氧氣出氣口、麻醉機(jī)進(jìn)氣口、麻醉機(jī)儲氣囊及一次性螺紋管Y型接口,術(shù)中易被污染的4個(gè)區(qū)域進(jìn)行細(xì)菌學(xué)采樣,隨后接種至血液培養(yǎng)基中培養(yǎng)、分離純化后再用微生物生化鑒定系統(tǒng)進(jìn)行鑒定,隨后進(jìn)行統(tǒng)計(jì)分析。術(shù)后對患者進(jìn)行隨訪。資料進(jìn)行整理后,對數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析。 結(jié)果： (1)麻醉機(jī)通氣系統(tǒng)培養(yǎng)出的定植菌均為條件致病菌,革蘭陽性菌占45.37%,主要為表皮葡萄球菌、棒狀桿菌等；革蘭陰性菌占15.74%,主要為黃桿菌屬；真菌占38.89%,主要是酵母樣真菌和類酵母樣真菌。 (2)麻醉通氣系統(tǒng)各部位定植菌陽性率不同,氧氣出氣口、麻醉機(jī)進(jìn)氣口、儲氣囊口及Y型連接口陽性率分別為11.8%、78.9%、3.9%和5.3%,差異有統(tǒng)計(jì)學(xué)意義,(P0.05)。定植菌主要存在于麻醉機(jī)進(jìn)氣口。 (3)麻醉通氣系統(tǒng)各個(gè)部位定植菌陽性率在T0、T1、T2時(shí)段分別為42.1%、27.6%、30.3%,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。 (4)術(shù)后患者下呼吸道感染率為0%。 結(jié)論： 1.本研究表明我院麻醉機(jī)通氣系統(tǒng)培養(yǎng)出的定植菌均為條件致病菌,主要定植于麻醉機(jī)進(jìn)氣口。 2.機(jī)械通氣時(shí)間在4h內(nèi),定植菌在麻醉通氣系統(tǒng)各個(gè)部位的定植數(shù)量不隨著時(shí)間的延長而增多。 3.我院層流手術(shù)間里的麻醉機(jī)未采取干預(yù),沒有增加引起下呼吸感染相關(guān)并發(fā)癥的幾率。
[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.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R614

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本文編號：1959978