气管插管全麻术后患者肺部感染危险因素的Meta分析
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摘要
目的系统评价气管插管全麻术后患者发生肺部感染的危险因素。方法检索Pub Med、中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、万方数据库(Wanfang)以及维普信息资源系统(VIP)中建库至2017年9月15日发表的气管插管全麻术后患者发生肺部感染的相关文献。2名研究员独立按照纳入与排除标准筛选文献、提取资料及质量评价后,采用Rev Man5.3软件进行Meta分析。结果最终纳入文献19篇。Meta分析显示,年龄、吸烟、急诊手术、合并基础疾病、气管导管留置时间、麻醉时间、气管插管方式、插管深度、插管熟练度(是否反复多次插管)、拔管指征、拔管延迟等与气管插管全麻术后患者发生肺部感染相关,各因素分析合并OR值及95%CI分别为3.19(2.58~3.95)、2.43(1.55~3.82)、2.45(1.42~4.24)、4.85(2.36~9.94)、4.96(2.08~11.84)、3.33(1.15~9.70)、1.49(1.06~2.09)、4.67(2.74~7.96)、2.52(2.14~2.98)、2.23(1.90~2.61)、3.91(3.18~4.81)。结论应严格把握气管插管全麻的应用指征,规范气管插管和麻醉复苏拔管过程的管理,做好患者准备,把握气管导管拔除时机,降低患者术后感染风险。
Objective To systematically assess risk factors for pulmonary infection in patients after tracheal intubation under general anesthesia.Methods Literatures published between the establishment of database and September 15,2017 were retrieved from Pub Med,China National Knowledge Infrastructure( CNKI),Chinese Biology Medicine( CBM) database,Wanfang database( Wanfang),and VIP database,data about pulmonary infection in patients after tracheal intubation under general anesthesia were collected. Literatures were screened,extracted,and evaluated according to inclusion and exclusion criteria by two reviewers,Meta-analysis was conducted using Rev Man 5.3 software.Results A total of 19 literatures were included for analysis. Meta-analysis showed that the following factors were associated with occurrence of pulmonary infection in patients after tracheal intubation under general anesthesia: age,smoking,emergency surgery,underlying disease,duration of tracheal intubation,duration of general anesthesia,method of intubation,depth of intubation,proficiency of intubation( whether intubation was repeated),indication of extubation,and delay of extubation. The combined OR values and 95%CI of each factor analysis were 3.19( 2.58-3.95),2.43( 1.55-3.82),2.45( 1.42-4.24),4.85( 2.36-9.94),4.96( 2.08-11.84),3.33( 1.15-9.70),1.49( 1.06-2.09),4.67( 2.74-7.96),2.52( 2.14-2.98),2.23( 1.90-2.61),and 3.91( 3.18-4.81),respectively.Conclusion It is important to grasp strictly the indication of general anesthesia for tracheal intubation,standardize management of tracheal intubation and extubation after anesthesia resuscitation,seize the opportunity to remove tracheal catheter,and reduce risk of postoperative infection.
Objective To systematically assess risk factors for pulmonary infection in patients after tracheal intubation under general anesthesia.Methods Literatures published between the establishment of database and September 15,2017 were retrieved from Pub Med,China National Knowledge Infrastructure( CNKI),Chinese Biology Medicine( CBM) database,Wanfang database( Wanfang),and VIP database,data about pulmonary infection in patients after tracheal intubation under general anesthesia were collected. Literatures were screened,extracted,and evaluated according to inclusion and exclusion criteria by two reviewers,Meta-analysis was conducted using Rev Man 5.3 software.Results A total of 19 literatures were included for analysis. Meta-analysis showed that the following factors were associated with occurrence of pulmonary infection in patients after tracheal intubation under general anesthesia: age,smoking,emergency surgery,underlying disease,duration of tracheal intubation,duration of general anesthesia,method of intubation,depth of intubation,proficiency of intubation( whether intubation was repeated),indication of extubation,and delay of extubation. The combined OR values and 95%CI of each factor analysis were 3.19( 2.58-3.95),2.43( 1.55-3.82),2.45( 1.42-4.24),4.85( 2.36-9.94),4.96( 2.08-11.84),3.33( 1.15-9.70),1.49( 1.06-2.09),4.67( 2.74-7.96),2.52( 2.14-2.98),2.23( 1.90-2.61),and 3.91( 3.18-4.81),respectively.Conclusion It is important to grasp strictly the indication of general anesthesia for tracheal intubation,standardize management of tracheal intubation and extubation after anesthesia resuscitation,seize the opportunity to remove tracheal catheter,and reduce risk of postoperative infection.
引文
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[15]朱永锋,王建平,张加强.气管插管全麻手术患者术后肺部感染的相关因素及预防对策[J].中华医院感染学杂志,2014,24(16):4083-4084.
[16]崔乃荣,贾珍,王建民.气管插管全麻术后患者下呼吸道感染的危险因素分析[J].中华医院感染学杂志,2015,25(8):1828-1829,1832.
[17]胡清波.气管插管全麻术后发生下呼吸道感染的麻醉相关因素探讨[J].临床研究,2015,23(6):96-97.
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[19]王方华,罗军,周林杰.全麻患者气管插管后下呼吸道感染危险因素分析[J].中华医院感染学杂志,2015,25(12):2793-2795.
[20]王秀清,秦海艳,刘晓婧.全麻术后下呼吸道感染调查与预防抗菌药物选择研究[J].中华医院感染学杂志,2015,25(21):4876-4878.
[21]陈静璐,陈琳,赵伟和,等.气管插管全麻患者术后下呼吸道感染的病原菌分布与预防[J].中华医院感染学杂志,2016,26(4):835-837.
[22]龙燕.气管插管全麻术后患者肺部感染的相关因素分析[J].中国社区医师,2017,33(23):140-141.
[23]吴继敏,胡英,金林飞.全身麻醉气管插管对患者手术后呼吸道感染的影响[J].中华医院感染学杂志,2017,27(4):880-883.
[24]张慧,黄焜,宗志勇,等.气管插管全身麻醉术后患者肺部感染现状[J].华西医学,2012,27(12):1910-1913.
[25]朱文伟,丁滢燕,陈志华.老年患者气管插管全麻后下呼吸道感染相关因素分析[J].中华医院感染学杂志,2013,23(7):1586-1587.
[26]Mahfoud F,Beck J,Raabe A.Intracranial pressure pulse amplitude during changes in head elevation:a new parameter for determining optimum cerebral perfusion pressure?[J].Acta Neurochirurgica,2010,152(3):443-450.
[27]李响.医院获得性肺炎危险因素及致病菌耐药情况分析[D].沈阳:中国医科大学,2012.
[28]柴艳红,田革新,薛海丹,等.气管插管全麻与术后肺部感染相关性研究进展[J].中华医院感染学杂志,2014,24(22):5718-5720.
[2]Certain C.Infectious Diseases Society of America[M].Ject Press,2012.
[3]Shamliyan T,Kane RL,Dickinson S.A systematic review of tools used to assess the quality of observational studies that examine incidence or prevalence and risk factors for diseases[J].J Clin Epidemiol,2010,63(10):1061-1070.
[4]麦劲壮,李河,方积乾,等.Meta分析中失安全系数的估计[J].循证医学,2006,6(5):297-300.
[5]王宝华.全麻气管插管后与下呼吸道感染关系探讨[J].中华医院感染学杂志,2002,12(4):286.
[6]包延丽,仝保敏,贾红轩.气管插管全麻术后下呼吸道感染的麻醉相关因素分析[J].中国感染控制杂志,2003,2(2):95-97.
[7]叶丹,卢次勇,李莲娜,等.气管插管全麻术后医院内呼吸道感染的影响因素[J].中华医院感染学杂志,2009,19(19):2543-2545.
[8]蔡小晖.气管插管全麻术后医院内肺部感染的危险因素分析[J].中华医院感染学杂志,2011,21(9):1780-1782.
[9]魏秀凤,王秀华,宋华宁.气管插管全麻患者术后医院获得性肺炎影响因素及预防措施[J].徐州医学院学报,2011,31(8):558-559.
[10]张希,陈红,居来提,等.全麻气管插管后下呼吸道感染原因分析[J].中华医院感染学杂志,2012,22(24):1651-1654.
[11]李红,陈永浩.气管插管全麻术后下呼吸道感染相关因素分析[J].中华医院感染学杂志,2013,23(17):4156-4157.
[12]王更富,刘国泽,张江锋.气管插管全麻患者术后下呼吸道感染相关因素分析[J].江苏医药,2013,39(14):1698-1699.
[13]吴天良.气管插管全麻患者术后肺部感染的相关因素分析及预防策略[J].中华医院感染学杂志,2013,23(7):1584-1585,1650.
[14]李永强,崔魁,沈彦波.气管插管全麻术后下呼吸道感染相关因素分析[J].中国药物经济学,2014(8):80-81.
[15]朱永锋,王建平,张加强.气管插管全麻手术患者术后肺部感染的相关因素及预防对策[J].中华医院感染学杂志,2014,24(16):4083-4084.
[16]崔乃荣,贾珍,王建民.气管插管全麻术后患者下呼吸道感染的危险因素分析[J].中华医院感染学杂志,2015,25(8):1828-1829,1832.
[17]胡清波.气管插管全麻术后发生下呼吸道感染的麻醉相关因素探讨[J].临床研究,2015,23(6):96-97.
[18]唐浩伦.气管插管全身麻醉术后肺部感染的危险因素分析[D].昆明:昆明医科大学,2015.
[19]王方华,罗军,周林杰.全麻患者气管插管后下呼吸道感染危险因素分析[J].中华医院感染学杂志,2015,25(12):2793-2795.
[20]王秀清,秦海艳,刘晓婧.全麻术后下呼吸道感染调查与预防抗菌药物选择研究[J].中华医院感染学杂志,2015,25(21):4876-4878.
[21]陈静璐,陈琳,赵伟和,等.气管插管全麻患者术后下呼吸道感染的病原菌分布与预防[J].中华医院感染学杂志,2016,26(4):835-837.
[22]龙燕.气管插管全麻术后患者肺部感染的相关因素分析[J].中国社区医师,2017,33(23):140-141.
[23]吴继敏,胡英,金林飞.全身麻醉气管插管对患者手术后呼吸道感染的影响[J].中华医院感染学杂志,2017,27(4):880-883.
[24]张慧,黄焜,宗志勇,等.气管插管全身麻醉术后患者肺部感染现状[J].华西医学,2012,27(12):1910-1913.
[25]朱文伟,丁滢燕,陈志华.老年患者气管插管全麻后下呼吸道感染相关因素分析[J].中华医院感染学杂志,2013,23(7):1586-1587.
[26]Mahfoud F,Beck J,Raabe A.Intracranial pressure pulse amplitude during changes in head elevation:a new parameter for determining optimum cerebral perfusion pressure?[J].Acta Neurochirurgica,2010,152(3):443-450.
[27]李响.医院获得性肺炎危险因素及致病菌耐药情况分析[D].沈阳:中国医科大学,2012.
[28]柴艳红,田革新,薛海丹,等.气管插管全麻与术后肺部感染相关性研究进展[J].中华医院感染学杂志,2014,24(22):5718-5720.