摘要：

目的：探讨高龄患者颌面部外伤手术全身麻醉气管插管术后发生下呼吸道感染的原因及危险因素，以便为临床提前干预提供依据。方法：收集2010年1月至2021年1月解放军联勤保障部队第九八八医院收治的300例颌面部外伤手术全身麻醉气管插管术高龄患者为研究对象，了解患者详细信息及病史，记录术后下呼吸道感染例数，对其发生可能的原因及危险因素进行系统分析。结果：300例行颌面部外伤手术的高龄患者中，40例发生下呼吸道感染，感染率为13.33%。下呼吸道感染者下呼吸道分泌物中分离出47株病原菌，其中革兰氏阳性菌13株，占27.66%；革兰氏阴性菌31株，占65.96%；真菌3株，占6.38%。多因素临床分析表明，伤后手术时间、手术持续时间、伤口有无污染物、术后拔管时间、术后6 h内有无呕吐、既往有慢性呼吸系统感染病史等因素均为全身麻醉后下呼吸道感染的可能原因及危险因素(P<0.05)；多因素logistic回归分析显示，伤后手术时间、手术持续时间、伤口有无污染物、术后拔管时间、术后6 h内呕吐等为全身麻醉术后下呼吸道感染的独立危险因素（P<0.05）。结论：高龄患者颌面部外伤手术行全身麻醉气管插管术后发生下呼吸道感染的概率高、危险因素多；针对可能的原因及危险因素，临床应提前干预，积极预防下呼吸道感染的发生，以提高患者术后的生活质量。

关键词: 高龄患者, 颌面部外伤, 全身麻醉, 下呼吸道感染, 危险因素

Abstract:

Objective: To explore the causes and risk factors of lower respiratory tract infection after general anesthesia and endotracheal intubation in elderly patients with maxillofacial trauma, and provide basis for clinical early intervention. Methods: A total of 300 elderly patients with maxillofacial trauma undergoing general anesthesia and endotracheal intubation were collected from January 2010 to January 2021. The detailed information and medical history of the patients were obtained, the number of cases of postoperative lower respiratory tract infection was recorded, and the possible causes and risk factors were systematically analyzed.Results: Forty of the 300 elderly patients who underwent maxillofacial trauma surgery had lower respiratory tract infection, and the infection rate was 13.33%. Forty-seven strains of pathogens were isolated from the lower respiratory tract secretions, including 13 strains of Gram-positive bacteria, accounting for 27.66%, 31 strains of Gram-negative bacteria, accounting for 65.96%, and 3 strains of fungi, accounting for 6.38% respectively. Multivariate clinical analysis showed that the possible causes and risk factors were time from injury to surgery, operation time duration, wound contamination, postoperative extubation time, vomiting within 6 hours after operation, and previous chronic respiratory infections (P<0.05); multivariate logistic regression analysis showed that time from injury to surgery, operation time duration, wound contamination, postoperative extubation time and vomiting within 6 hours were independent risk factors of lower respiratory tract infection after general anesthesia (P<0.05). Conclusion: Lower respiratory tract infection after general anesthesia and endotracheal intubation in elderly patients with maxillofacial trauma is in high probability and there are many risk factors; according to the possible causes and risk factors, clinical intervention should be carried out in advance to actively prevent the occurrence of lower respiratory tract infection, so as to improve the quality of life of patients after operation.

Key words: elderly patients, maxillofacial trauma, general anesthesia, lower respiratory tract infection, risk factors

中图分类号: 

• R782