摘要
目的探讨骨科全身麻醉手术后转重症监护病房(ICU)的老年患者呼吸机相关肺炎(VAP)的发生情况及其影响因素。方法选取于全身麻醉下行骨科手术后转ICU行机械通气治疗的178例老年患者为研究对象,统计患者VAP的发生情况,采用单因素及多因素Logistic回归分析影响患者发生VAP的因素。结果178例骨科全身麻醉手术后转ICU的老年患者中,有56例发生VAP,发生率为31.46%。单因素分析结果显示,2组患者在年龄、反流误吸、抽烟史、气管插管前口腔清洁、每日更换冷凝水、罹患糖尿病、既往合并COPD、机械通气时间、合并低蛋白血症、每日口咽部护理、留置胃管及使用抑酸剂等方面比较,差异有统计学意义(P<0.05);多因素Logistic回归分析结果显示,年龄≥75岁、反流误吸、机械通气时间≥3 d、留置胃管以及使用抑酸剂是骨科全身麻醉手术后转ICU的老年患者发生VAP的危险因素(OR>1,P<0.05),而气管插管前口腔清洁、每日更换冷凝水以及每日口咽部护理是骨科全身麻醉手术后转ICU的老年患者发生VAP的保护性因素(OR<1,P<0.05)。结论骨科全身麻醉手术后转ICU的老年患者VAP的发生率较高,且与患者年龄、反流误吸、机械通气时间、留置胃管、使用抑酸剂、气管插管前口腔清洁、每日更换冷凝水及每日口咽部护理等密切相关。
Objective To investigate the incidence and influencing factors of ventilator-associated pneumonia(VAP)in elderly patients transferred to intensive care unit(ICU)after orthopedic surgery under general anesthesia.Methods A total of 178 elderly patients who were transferred to ICU for mechanical ventilation after orthopedic surgery under general anesthesia were selected as the research objects.The incidence of VAP in these patients was counted.Univariate and multivariate Logistic regression were used to analyze the factors influencing the occurrence of VAP in patients.Results Among 178 elderly patients who were transferred to ICU after orthopedic surgery under general anesthesia,56 cases developed VAP,with an incidence rate of 31.46%.The results of univariate analysis showed that there were statistically significant differences in age,reflux aspiration,smoking history,oral cavity cleaning before tracheal intubation,daily replacement of condensed water,diabetes,previous combination with COPD,mechanical ventilation time,combination with hypoproteinemia,daily oropharyngeal care,indwelling gastric tube and use of acid inhibitor between the two groups(P<0.05).The results of multivariate Logistic regression analysis showed that age≥75 years old,reflux aspiration,mechanical ventilation time≥3 days,indwelling gastric tube and use of acid inhibitor were the risk factors for VAP in elderly patients transferred to ICU after orthopedic surgery under general anesthesia(OR>1,P<0.05),while the oral cavity cleaning before tracheal intubation,daily replacement of condensed water and daily oropharyngeal care were the protective factors for VAP in elderly patients transferred to ICU after orthopedic surgery under general anesthesia(OR<1,P<0.05).Conclusion The incidence of VAP in elderly patients transferred to ICU after orthopedic surgery under general anesthesia is higher,which is closely related to the age,reflux aspiration,mechanical ventilation time,indwelling gastric tube,use of acid inhibitor,oral cavity cleaning before trac
作者
张嫚
王洁
陈茹
吴燕燕
蔡丛
ZHANG Man;WANG Jie;CHEN Ru;WU Yan-yan;CAI Cong(Department of Critical Care Medicine,Nanjing Integrated Traditional Chinese and Western Medicine Hospital Affiliated to Nanjing University of Chinese Medicine,Nanjing Jiangsu 210014,China)
出处
《局解手术学杂志》
2021年第10期890-893,共4页
Journal of Regional Anatomy and Operative Surgery
关键词
骨科手术
老年患者
重症监护病房
呼吸机相关肺炎
影响因素
orthopedic surgery
elderly patients
intensive care unit
ventilator-associated pneumonia
influencing factors
