CAJ | 학술논문

目的：探讨气管插管全麻术患者术后发生下呼吸道感染的危险因素，为控制降低术后感染的发生提供参考依据。方法选取2012年6月－2014年6月住院行气管插管全麻术后发生下呼吸道感染的1013例患者为研究对象，对发生下呼吸道感染的60例患者进行相关干预治疗，比较感染患者在干预前后的体温、中性粒细胞比例、白细胞总数以及降钙素原（PCT ）值；分析患者发生下呼吸道感染的相关因素，并进一步通过多因素 logistic回归分析患者发生下呼吸道感染的危险因素；采用SPSS19．0软件进行统计分析。结果干预后患者的体温、中性粒细胞比例、白细胞总数以及PCT值明显低于干预前，差异有统计学意义（P＜0．05）；单因素分析显示，年龄、吸烟史、合并基础疾病、麻醉时间、插管途径、插管部位、插管深度以及拔管时间与下呼吸道感染的发生具有相关性（P＜0．05）；多因素 logistic回归分析显示，年龄、麻醉时间、插管途径、插管部位、插管深度以及拔管时间是患者发生下呼吸道感染的独立危险因素（P＜0．05）。结论患者气管插管全麻术后均会增加下呼吸道感染风险，临床上应该加强对该危险因素的控制以降低患者发生下呼吸道感染的风险。
목적：탐토기관삽관전마술환자술후발생하호흡도감염적위험인소，위공제강저술후감염적발생제공삼고의거。방법선취2012년6월－2014년6월주원행기관삽관전마술후발생하호흡도감염적1013례환자위연구대상，대발생하호흡도감염적60례환자진행상관간예치료，비교감염환자재간예전후적체온、중성립세포비례、백세포총수이급강개소원（PCT ）치；분석환자발생하호흡도감염적상관인소，병진일보통과다인소 logistic회귀분석환자발생하호흡도감염적위험인소；채용SPSS19．0연건진행통계분석。결과간예후환자적체온、중성립세포비례、백세포총수이급PCT치명현저우간예전，차이유통계학의의（P＜0．05）；단인소분석현시，년령、흡연사、합병기출질병、마취시간、삽관도경、삽관부위、삽관심도이급발관시간여하호흡도감염적발생구유상관성（P＜0．05）；다인소 logistic회귀분석현시，년령、마취시간、삽관도경、삽관부위、삽관심도이급발관시간시환자발생하호흡도감염적독립위험인소（P＜0．05）。결론환자기관삽관전마술후균회증가하호흡도감염풍험，림상상응해가강대해위험인소적공제이강저환자발생하호흡도감염적풍험。
OBJECTIVE To explore the risk factors for postoperative lower respiratory tract infections in the pa‐tients undergoing endotracheal intubation under general anesthesia so as to provide guidance for control of the post‐operative infections .METHODS From Jun 2012 to Jun 2014 ,a total of 1 023 hospitalized patients who underwent the endotracheal intubation under general anesthesia and were complicated with postoperative lower respiratory tract infections were recruited as the study objects ,the relevant interventions were taken to the 60 patients with complicated lower respiratory tract infections .The body temperature ,ratio of neutrophils ,total white blood cells counts ,and procalcitonin PCT value of the patients with infections were observed and compared before and after the intervention;the related factors for the lower respiratory tract infections were analyzed ,the multivariate logis‐tic regression analysis was further employed to screen out the risk factors for the lower respiratory tract infections , and the statistical analysis was performed with the use of SPSS19 .0 software .RESULTS The body temperature , ratio of neutrophils ,total white blood cells counts ,and PCT value were significantly lower after the intervention than before the intervention(P<0 .05) .The univariate analysis showed that the incidence of lower respiratory tract infections was associated with the age ,smoking history ,complication of underlying disease ,anesthesia time , catheterization type ,catheterization site ,intubation depth ,and extubation time (P<0 .05);the multivariate lo‐gistic regression analysis indicated that the age ,anesthesia time ,catheterization type ,catheterization site ,intuba‐tion depth ,and extubation time were the independent risk factors for the lower respiratory tract infections (P<0 .05) .CONCLUSION The endotracheal intubation under general anesthesia may increase the risk of lower respira‐tory tract infections ,and it is necessary for the hospital to strengthen the control of the risk factors so as to reduce the incidence of lower respiratory tract infections .