張慧 1 , 黃焜 2 , 宗志勇 1 , 尹維佳 1 , 蒲丹 1 , 劉明 3
  • 四川大學(xué)華西醫(yī)院(成都,610041)1醫(yī)教部感染管理科,2 麻醉科,3骨科;

對采用氣管插管進(jìn)行全身麻醉(全麻)術(shù)后發(fā)生肺部感染的文獻(xiàn)進(jìn)行回顧,從術(shù)前、術(shù)中、術(shù)后3個(gè)方面分析其危險(xiǎn)因素,總結(jié)預(yù)防控制措施。分析顯示,高齡、長期吸煙史、麻醉時(shí)間與導(dǎo)管留置時(shí)間、術(shù)前呼吸道護(hù)理、術(shù)后鎮(zhèn)痛及無菌操作技術(shù)等均可影響全麻術(shù)后肺部感染的發(fā)生率,需對上述危險(xiǎn)因素進(jìn)行針對性處理,如術(shù)前戒煙、縮短麻醉時(shí)間、術(shù)前霧化吸入、插管過程嚴(yán)格無菌操作等,均可有效地預(yù)防肺部感染。

引用本文: 張慧,黃焜,宗志勇,尹維佳,蒲丹,劉明. 氣管插管全身麻醉術(shù)后患者肺部感染現(xiàn)狀. 華西醫(yī)學(xué), 2012, 27(12): 1910-1913. doi: 復(fù)制

1.  王寶華. 全麻氣管插管后與下呼吸道感染關(guān)系探討[J]. 中華醫(yī)院感染學(xué)雜志, 2002, 12(4): 286.
2.  胡國宏. 麻醉機(jī)全麻手術(shù)后患者肺部感染臨床分析[J]. 臨床和實(shí)驗(yàn)醫(yī)學(xué)雜志, 2010, 9(12): 892-893.
3.  孫駿, 匡勇, 史萌, 等. 骨科老年臥床病人獲得性肺炎的臨床特點(diǎn)及相關(guān)性研究[J]. 臨床醫(yī)學(xué)工程, 2010, 17(5): 27-29.
4.  吳勵(lì)文, 陳棉生, 鄭良杰, 等. 全麻支氣管插管與下呼吸道感染關(guān)系的調(diào)查[ J] . 中華醫(yī)院感染學(xué)雜志, 2006, 16(5): 511 -513.
5.  王媛, 王金保, 陳俊卓, 等. 食管腫瘤氣管插管全麻術(shù)后肺部感染回顧性分析[J]. 臨床誤診誤治, 2011, 24(4): 9-11.
6.  王華慶, 徐暉, 王文偉, 等. 71例全身麻醉后下呼吸道感染患者的臨床分析[J]. 中華醫(yī)院感染學(xué)雜志, 2012, 22(5): 933-934.
7.  黃曉霞, 袁海軍, 杜光生.氣管插管全麻術(shù)后患者下呼吸道感染情況分析[J]. 中華醫(yī)院感染學(xué)雜志, 2012, 22(8): 1583-1584.
8.  Agostini P, Cieslik H, Rathinam S, et al. Postoperative pulmonary complications following thoracic surgery: are there any modifiable risk factors? [J]. Thorax, 2010, 65(9): 815-818.
9.  朱華東, 周程. 全麻氣管插管并發(fā)下呼吸道感染因素分析[J]. 中華醫(yī)院感染學(xué)雜志, 2011, 21(18):3832-3834.
10.  吳勵(lì)文, 陳棉生, 鄭良杰. 全麻肺隔離技術(shù)與肺部感染的關(guān)系[J]. 實(shí)用醫(yī)技雜志, 2006, 13(1): 92-94.
11.  馬靜, 邢寶平, 唐素娟. 二羥丙茶堿預(yù)防老年全麻手術(shù)后肺部感染[J]. 中華全科醫(yī)學(xué), 2010, 8(9): 1116-1117.
12.  張進(jìn)川, 戴建業(yè), 樊謹(jǐn). 老年卡氏肺孢子菌肺炎的診斷和治療[J].中國全科醫(yī)學(xué), 2008, 11(4): 279-281.
13.  Belda J, Cavalcanti M, Ferrer M, et al. Bronchial colonization and postoperative respiratory infections in patients undergoing lung cancer surgery[J]. Chest, 2005, 128(3): 1571-1579.
14.  蔡小暉. 氣管插管全麻術(shù)后醫(yī)院內(nèi)肺部感染的危險(xiǎn)因素分析[J]. 中華醫(yī)院感染學(xué)雜志, 2011, 21(9): 1780-1782.
15.  Silva DR, Gazzana MB, Knorst MM. Merit of preoperative clinical findings and functional pulmonary evaluation as predictors of postoperative pulmonary complications[J]. Rev Assoc Med Bras, 2010, 56(5): 551-557.
16.  王妍, 顧勤. 建立人工氣道時(shí)限與肺部感染病原菌耐藥的相關(guān)性分析[J]. 中華醫(yī)院感染學(xué)雜志, 2008, 18(12): 1701-1703.
17.  魏成敏, 梁玉杰,李福昌. 全麻手術(shù)患者并發(fā)呼吸道感染危險(xiǎn)因素探討[J]. 中華醫(yī)院感染學(xué)雜志, 2011, 21(17): 3606-3607.
18.  von Ungern-Sternberg BS, Boda K, Chambers NA, et al. Risk assessment for respiratory complications in paediatric anaesthesia: a prospective cohort study[J]. Lancet, 2010, 376(9743): 773-783.
19.  楊紅暉, 姚小紅, 黃秀良. 全麻氣管插管術(shù)后患者肺部感染的調(diào)查分析[J]. 中華醫(yī)院感染學(xué)雜志, 2009, 19(21): 2868-2869.
20.  Mehta KV, Lee HC, Loh JS. Mechanical thromboprophylaxis for patients undergoing hip fracture surgery[J]. J OrthopSurg (Hong Kong), 2010, 18(3): 287-289.
21.  Hartmann B, Sucke J, Brammen D, et al. Impact of inadequate surgical antibiotic prophylaxis on preoperative outcome and length of stay on ICU in general and trauma surgery. Analysis using automated data collection[J]. Int J Antimicrob Agents, 2005, 25(3): 231-236.
22.  Chong CP, Street PR. Pneumonia in the elderly: a review of severity assessment, prognosis, mortality, prevention, and treatment[J]. South Med J, 2008, 101 (11): 1134-1140; quiz 1132, 1179.
23.  Al- Sarraf N, Thalib L, Hughes A, et al. Effect of smoking on short- term outcome of patients undergoing coronary artery bypass surgery[J].Ann Thorac Surg,2008,86(2): 517-523..
24.  Law S, Wong KH, Kwok KF, et al. Predictive factors for postoperative pulmonary complications and mortality after esophagectomy for cancer[J]. Ann Surg, 2004, 240(5): 791-800 .
25.  孫默, 宋一民, 許評, 等. 降低氣管插管全麻腹部手術(shù)后肺感染發(fā)生率的措施[J]. 中國初級衛(wèi)生保健, 2003, 17(7): 77.
26.  孔慶玲, 馬秋霞, 丁兆紅. 雙氧水口腔深漱口降低擇期手術(shù)全身麻醉氣管插管致肺部感染的研究[J]. 中國醫(yī)藥, 2011, 6(8): 926-927.
27.  巫香球, 趙明紅. 口腔護(hù)理預(yù)防氣管插管全醉術(shù)后下呼吸道感染效果觀察[J]. 中華醫(yī)院感染學(xué)雜志, 2011, 21(11): 2215-2216.
28.  曹贊. 手術(shù)室麻醉與下呼吸道感染的相關(guān)因素分析[J]. 中華醫(yī)院感染學(xué)雜志, 2011, 21(13):2704-2705.
29.  王軍會(huì), 蔣優(yōu)君, 徐元紅, 等. 全麻術(shù)后下呼吸道感染患者免疫狀態(tài)變化分析[J]. 中華醫(yī)院感染學(xué)雜志, 2011, 21(22):4693-4695.
30.  溫春娟, 孫丹馥, 李延珠. 全麻氣管插管術(shù)后青霉素霧化吸入的臨床應(yīng)用[J].黑龍江醫(yī)學(xué), 2002, 26(6):432.
31.  馮彩玲, 揭海英. 氣管插管全身麻醉術(shù)后早期霧化減少肺部感染發(fā)生的觀察分析[J]. 全科護(hù)理, 2008, 6(29): 2662.
32.  雷勇, 姜玉榮, 蘇云, 等. 霧化吸入起始時(shí)間對減輕全麻腹部術(shù)后肺部炎癥反應(yīng)的研究[J]. 中國誤診學(xué)雜志, 2012, 12(1):82-83.
33.  Chodak GW, Plaut ME. Use of systemic antibiotics for prophylaxis in surgery: a critical review[J]. Arch Surg, 1977, 112(3): 326-334.
34.  May AK, Fleming SB, Carpenter RO, et al. Influence of broad-spectrum antibiotic prophylaxis on intracranial pressure monitor infections and subsequent infections complications in head-injured patients[J]. Surg Infect (Larchmt), 2006, 7(5): 409-417.
35.  Fonseea SN, Kunzle SR, Junqueira MJ, et al. Implementing 1-dose antibiotic prophylaxis for prevention of surgical site infection[J]. Arch Surg, 2006, 141(11): 1109-1113.
36.  Kerendi F, Halkos ME, Puskas JD, et al. Impact of off-pump coronary artery bypass graft surgery on postoperative pulmonary complications in patients with chronic lung disease[J]. Ann Thorac Surg, 2011, 91(1): 8-15.
  1. 1.  王寶華. 全麻氣管插管后與下呼吸道感染關(guān)系探討[J]. 中華醫(yī)院感染學(xué)雜志, 2002, 12(4): 286.
  2. 2.  胡國宏. 麻醉機(jī)全麻手術(shù)后患者肺部感染臨床分析[J]. 臨床和實(shí)驗(yàn)醫(yī)學(xué)雜志, 2010, 9(12): 892-893.
  3. 3.  孫駿, 匡勇, 史萌, 等. 骨科老年臥床病人獲得性肺炎的臨床特點(diǎn)及相關(guān)性研究[J]. 臨床醫(yī)學(xué)工程, 2010, 17(5): 27-29.
  4. 4.  吳勵(lì)文, 陳棉生, 鄭良杰, 等. 全麻支氣管插管與下呼吸道感染關(guān)系的調(diào)查[ J] . 中華醫(yī)院感染學(xué)雜志, 2006, 16(5): 511 -513.
  5. 5.  王媛, 王金保, 陳俊卓, 等. 食管腫瘤氣管插管全麻術(shù)后肺部感染回顧性分析[J]. 臨床誤診誤治, 2011, 24(4): 9-11.
  6. 6.  王華慶, 徐暉, 王文偉, 等. 71例全身麻醉后下呼吸道感染患者的臨床分析[J]. 中華醫(yī)院感染學(xué)雜志, 2012, 22(5): 933-934.
  7. 7.  黃曉霞, 袁海軍, 杜光生.氣管插管全麻術(shù)后患者下呼吸道感染情況分析[J]. 中華醫(yī)院感染學(xué)雜志, 2012, 22(8): 1583-1584.
  8. 8.  Agostini P, Cieslik H, Rathinam S, et al. Postoperative pulmonary complications following thoracic surgery: are there any modifiable risk factors? [J]. Thorax, 2010, 65(9): 815-818.
  9. 9.  朱華東, 周程. 全麻氣管插管并發(fā)下呼吸道感染因素分析[J]. 中華醫(yī)院感染學(xué)雜志, 2011, 21(18):3832-3834.
  10. 10.  吳勵(lì)文, 陳棉生, 鄭良杰. 全麻肺隔離技術(shù)與肺部感染的關(guān)系[J]. 實(shí)用醫(yī)技雜志, 2006, 13(1): 92-94.
  11. 11.  馬靜, 邢寶平, 唐素娟. 二羥丙茶堿預(yù)防老年全麻手術(shù)后肺部感染[J]. 中華全科醫(yī)學(xué), 2010, 8(9): 1116-1117.
  12. 12.  張進(jìn)川, 戴建業(yè), 樊謹(jǐn). 老年卡氏肺孢子菌肺炎的診斷和治療[J].中國全科醫(yī)學(xué), 2008, 11(4): 279-281.
  13. 13.  Belda J, Cavalcanti M, Ferrer M, et al. Bronchial colonization and postoperative respiratory infections in patients undergoing lung cancer surgery[J]. Chest, 2005, 128(3): 1571-1579.
  14. 14.  蔡小暉. 氣管插管全麻術(shù)后醫(yī)院內(nèi)肺部感染的危險(xiǎn)因素分析[J]. 中華醫(yī)院感染學(xué)雜志, 2011, 21(9): 1780-1782.
  15. 15.  Silva DR, Gazzana MB, Knorst MM. Merit of preoperative clinical findings and functional pulmonary evaluation as predictors of postoperative pulmonary complications[J]. Rev Assoc Med Bras, 2010, 56(5): 551-557.
  16. 16.  王妍, 顧勤. 建立人工氣道時(shí)限與肺部感染病原菌耐藥的相關(guān)性分析[J]. 中華醫(yī)院感染學(xué)雜志, 2008, 18(12): 1701-1703.
  17. 17.  魏成敏, 梁玉杰,李福昌. 全麻手術(shù)患者并發(fā)呼吸道感染危險(xiǎn)因素探討[J]. 中華醫(yī)院感染學(xué)雜志, 2011, 21(17): 3606-3607.
  18. 18.  von Ungern-Sternberg BS, Boda K, Chambers NA, et al. Risk assessment for respiratory complications in paediatric anaesthesia: a prospective cohort study[J]. Lancet, 2010, 376(9743): 773-783.
  19. 19.  楊紅暉, 姚小紅, 黃秀良. 全麻氣管插管術(shù)后患者肺部感染的調(diào)查分析[J]. 中華醫(yī)院感染學(xué)雜志, 2009, 19(21): 2868-2869.
  20. 20.  Mehta KV, Lee HC, Loh JS. Mechanical thromboprophylaxis for patients undergoing hip fracture surgery[J]. J OrthopSurg (Hong Kong), 2010, 18(3): 287-289.
  21. 21.  Hartmann B, Sucke J, Brammen D, et al. Impact of inadequate surgical antibiotic prophylaxis on preoperative outcome and length of stay on ICU in general and trauma surgery. Analysis using automated data collection[J]. Int J Antimicrob Agents, 2005, 25(3): 231-236.
  22. 22.  Chong CP, Street PR. Pneumonia in the elderly: a review of severity assessment, prognosis, mortality, prevention, and treatment[J]. South Med J, 2008, 101 (11): 1134-1140; quiz 1132, 1179.
  23. 23.  Al- Sarraf N, Thalib L, Hughes A, et al. Effect of smoking on short- term outcome of patients undergoing coronary artery bypass surgery[J].Ann Thorac Surg,2008,86(2): 517-523..
  24. 24.  Law S, Wong KH, Kwok KF, et al. Predictive factors for postoperative pulmonary complications and mortality after esophagectomy for cancer[J]. Ann Surg, 2004, 240(5): 791-800 .
  25. 25.  孫默, 宋一民, 許評, 等. 降低氣管插管全麻腹部手術(shù)后肺感染發(fā)生率的措施[J]. 中國初級衛(wèi)生保健, 2003, 17(7): 77.
  26. 26.  孔慶玲, 馬秋霞, 丁兆紅. 雙氧水口腔深漱口降低擇期手術(shù)全身麻醉氣管插管致肺部感染的研究[J]. 中國醫(yī)藥, 2011, 6(8): 926-927.
  27. 27.  巫香球, 趙明紅. 口腔護(hù)理預(yù)防氣管插管全醉術(shù)后下呼吸道感染效果觀察[J]. 中華醫(yī)院感染學(xué)雜志, 2011, 21(11): 2215-2216.
  28. 28.  曹贊. 手術(shù)室麻醉與下呼吸道感染的相關(guān)因素分析[J]. 中華醫(yī)院感染學(xué)雜志, 2011, 21(13):2704-2705.
  29. 29.  王軍會(huì), 蔣優(yōu)君, 徐元紅, 等. 全麻術(shù)后下呼吸道感染患者免疫狀態(tài)變化分析[J]. 中華醫(yī)院感染學(xué)雜志, 2011, 21(22):4693-4695.
  30. 30.  溫春娟, 孫丹馥, 李延珠. 全麻氣管插管術(shù)后青霉素霧化吸入的臨床應(yīng)用[J].黑龍江醫(yī)學(xué), 2002, 26(6):432.
  31. 31.  馮彩玲, 揭海英. 氣管插管全身麻醉術(shù)后早期霧化減少肺部感染發(fā)生的觀察分析[J]. 全科護(hù)理, 2008, 6(29): 2662.
  32. 32.  雷勇, 姜玉榮, 蘇云, 等. 霧化吸入起始時(shí)間對減輕全麻腹部術(shù)后肺部炎癥反應(yīng)的研究[J]. 中國誤診學(xué)雜志, 2012, 12(1):82-83.
  33. 33.  Chodak GW, Plaut ME. Use of systemic antibiotics for prophylaxis in surgery: a critical review[J]. Arch Surg, 1977, 112(3): 326-334.
  34. 34.  May AK, Fleming SB, Carpenter RO, et al. Influence of broad-spectrum antibiotic prophylaxis on intracranial pressure monitor infections and subsequent infections complications in head-injured patients[J]. Surg Infect (Larchmt), 2006, 7(5): 409-417.
  35. 35.  Fonseea SN, Kunzle SR, Junqueira MJ, et al. Implementing 1-dose antibiotic prophylaxis for prevention of surgical site infection[J]. Arch Surg, 2006, 141(11): 1109-1113.
  36. 36.  Kerendi F, Halkos ME, Puskas JD, et al. Impact of off-pump coronary artery bypass graft surgery on postoperative pulmonary complications in patients with chronic lung disease[J]. Ann Thorac Surg, 2011, 91(1): 8-15.