全麻氣管插管肺部感染途徑及病原菌分布分析

王海波　陳長江

【摘要】 目的：探討全麻氣管插管肺部感染途徑及病原菌分布。方法：選取2014年9月-2016年9月在本院住院需氣管插管全身麻醉手術(shù)的患者200例作為研究對象，回顧性分析其臨床資料。在麻醉前后采集口咽部分泌物、胃液、麻醉機回路做細菌培養(yǎng)，用全自動微生物鑒定系統(tǒng)進行細菌生化鑒定，分析細菌譜的變化，對比患者下呼吸道痰液與口咽部、胃內(nèi)、麻醉機回路肺部感染菌株的一致率。結(jié)果：全麻氣管插管術(shù)后200例患者中，肺部總感染率為21.00%（42/200）；其中術(shù)后24 h內(nèi)拔除氣管插管的120例中肺部感染率為5.83%（7/120）；24 h后拔管的80例中肺部感染率為43.75%（35/80）。42例肺部感染患者檢出感染病原微生物以革蘭陰性菌為主69.05%（29/42），革蘭陽性菌次之19.05%（8/42），真菌感染占11.90%（5/42）。42例肺部感染患者下呼吸道痰液中33例篩選出與口咽部、胃內(nèi)、麻醉機回路內(nèi)有相同菌株，共檢出菌株50株6種，其中鮑氏不動桿菌分布最多占32.00%（16/50），其次為金黃色葡萄球菌16.00%（8/50）、白色假絲酵母菌16.00%（8/50）、大腸埃希菌14.00%（7/50）、銅綠假單胞菌14.00%（7/50）、肺炎克雷伯菌8.00%（4/50）。6種標本菌株來源的感染途徑：胃液占52.38%（22/42），口咽分泌物占30.95%（13/42），麻醉機回路占16.67%（7/42）。胃液、口咽分泌物感染途徑術(shù)后24 h內(nèi)拔除氣管導管肺部感染占比均高于24 h后拔氣管導管，而麻醉機回路感染途徑術(shù)后24 h內(nèi)拔除氣管導管肺部感染占比低于24 h后拔氣管導管（P<0.05）。結(jié)論：氣管插管全麻手術(shù)患者的肺部感染發(fā)生率較高，鮑氏不動桿菌為主要病原菌，需重點監(jiān)測其感染途徑，全麻氣管插管的時間不同，其感染途徑也有差異，胃-咽-下呼吸道的逆行感染為肺部感染的重要感染途徑，應針對氣管插管全麻患者肺部感染途徑，采取相應預防措施，降低全麻患者術(shù)后肺部感染率。

【關鍵詞】 全麻氣管插管； 肺部感染途徑； 病原菌分布

Analysis of the Route of Pulmonary Infection and the Distribution of Pathogens in General Anesthesia/WANG Hai-bo，CHEN Chang-jiang.//Medical Innovation of China，2017，14（30）：061-064

【Abstract】 Objective：To investigate the route of pulmonary infection and the distribution of pathogens in general anesthesia.Method：From September 2014 to September 2016 in our hospital，200 patients with general anesthesia for tracheal intubation were selected as the subjects，and the clinical data were analyzed retrospectively.Before and after anesthesia，some oropharyngeal secretions，gastric juice and anesthesia circuit were collected and used for bacterial culture.Biochemical identification of bacteria was carried out with a full automatic microbial identification system，and the changes of bacterial spectrum were analyzed.The consistency rate between the lower respiratory tract sputum and oropharynx，stomach and internal loop of anesthesia machine in pulmonary infection were compared.Result：The pulmonary infection rate was 21.00%（42/200） in 200 patients after general anesthesia and endotracheal intubation.Among them，the pulmonary infection rate was 5.83%（7/120）in 120 cases of underwent tracheal intubation after 24 h，and the pulmonary infection rate of 43.75%（35/80） in 80 patients after more than 24 h.Among the 42 cases of pulmonary infection，the pathogens were mainly gram negative bacteria of 69.05%（29/42），gram positive bacteria was 19.05%（8/42），fungal infection was 11.90%（5/42）.In 42 cases of pulmonary infection，there were 33 cases of the same strain in the oropharynx，stomach，anesthesia machine and the lower respiratory tract sputum，there were 50 strains and 6 cases，one of the largest distribution of Acinetobacter Baumannii accounted for 32.00%（16/50），followed by Staphylococcus Aureus 16.00%（8/50），Candida Albicans 16.00%（8/50） and Escherichia Coli 14.00%（7/50），Pseudomonas Aeruginosa 14.00%（7/50），Klebsiella Pneumoniae 8.00%（4/50）.The route of infection of 6 specimen strains were：gastric juice accounted for 52.38%（22/42），oropharyngeal secretions accounted for 30.95%（13/42），anesthesia machine loop accounted for 16.67%（7/42）.Gastric juice，oropharyngeal secretions within 24 h after extubation pulmonary infection were higher than those the proportion of 24 h after tracheal extubation approach surgery，anesthesia machine and loop infection within 24 h after surgery extubation pulmonary infection accounted for less than that 24 hendprint

after extubation（P<0.05）.Conclusion：Patients with general anesthesia with tracheal intubation of the high rate of pulmonary infection，Acinetobacter Baumannii is the main pathogenic bacteria，to focus on monitoring the infection route，the time of tracheal intubation is difference，the routes of infection are different，the retrograde infection of the stomach-pharynx-lower respiratory tract is an important infection route for lung infection，should be aimed at the trachea intubation of pulmonary infection in patients with infection，and put forward the corresponding preventive measures，to reduce the infection rate in patients with general anesthesia.

【Key words】 General anesthesia endotracheal intubation； Pulmonary infection route； Distribution of pathogens

First-authors address：The Sixth Peoples Hospital of Huizhou City，Huizhou 516211，China

doi：10.3969/j.issn.1674-4985.2017.30.018

現(xiàn)今氣管插管全身麻醉是臨床常用的麻醉方式，能夠提供良好的手術(shù)環(huán)境，使患者在無意識狀態(tài)下接受手術(shù)，避免了區(qū)域麻醉阻滯不全導致的疼痛感受，更加注重對患者的關懷，逐漸被患者和醫(yī)生所接受[1-2]。……