口腔颌面部全麻手术后呼吸道感染及相关因素分析

本文由“小麻哥的日常”授权转载

摘要译文（供参考）

口腔颌面部全麻手术后呼吸道感染及相关因素分析

前言：

目的探讨全麻下口腔颌面部手术后呼吸道感染的发生及相关因素。

方法：

494例口腔颌面部手术患者在气管插管全麻下分为非感染组(n=469)和感染组(n=25)。

选取同期健康体检者494例，建立病原菌分类树模型，分析病原菌的分布、主要病原菌的耐药性及术后呼吸道感染的相关影响因素。

采用logistic回归分析筛选呼吸道感染的影响因素，根据影响因素建立分类回归树(CART)模型，绘制受试者工作特性(ROC)曲线，评价其准确性。

结果：

铜绿假单胞菌对头孢唑林高度耐药，对头孢哌酮、环丙沙星、诺氟沙星、亚胺培南更敏感，金黄色葡萄球菌对庆大霉素高度耐药，对万古霉素更敏感。

年龄≥60岁、有肺部疾病史、手术时间≥4h、麻醉通气时间≥120min、气管插管是呼吸道感染的独立影响因素(p<0.05)。

增益图、指数图和风险值的结果表明，CART模型对术后呼吸道感染的风险具有较高的预测值。

ROC曲线下面积为0.869[95%置信区间：0.795-0.947]。

结论：

cart模型具有较高的预测价值，可降低术后感染的风险。

关键字：

口腔颌面外科；全身麻醉；感染；影响因素；致病菌。

原文摘要

Respiratory tract infection after oral and maxillofacial surgery under general anesthesia and related factors

Introduction: 

We aimed to explore the respiratory tract infection after oral and maxillofacial surgery under general anesthesia and related factors.

Methodology: 

A total of 494 patients receiving oral and maxillofacial surgery under general anesthesia with tracheal intubation were assigned to a non-infection group (n=469) and an infection group (n=25). Another 494 healthy people undergoing physical examination in the same period were enrolled to establish a classification tree model. The distribution of pathogens, drug resistance of main pathogens, and related influencing factors of postoperative respiratory tract infection were analyzed. The influencing factors of respiratory tract infection were screened by logistic regression analysis. After construction of the classification and regression tree (CART) model based on the influencing factors, the accuracy was evaluated by plotting receiver operating characteristic (ROC) curve.

Results: 

Pseudomonas aeruginosa was highly resistant to cefazolin and more sensitive to cefoperazone, ciprofloxacin, norfloxacin and imipenem. Staphylococcus aureus was highly resistant to gentamicin and more sensitive to vancomycin. Age ≥ 60 years old, history of lung diseases, operation time ≥ 4 h, anesthesia ventilation time ≥ 120 min, and orotracheal intubation were independent influencing factors of respiratory tract infection (p< 0.05). The results of the gain chart, index map, and Risk value indicated a high predictive value of the CART model for the risk of postoperative respiratory tract infection. The area under the ROC curve was 0.869 [95% confidence interval: 0.795-0.947].

Conclusions: 

The CART model has a high predictive value and may reduce the risk of postoperative infection.

Keywords: 

Oral and maxillofacial surgery; general anesthesia; infection; influencing factor; pathogen.

免责声明：

文中所涉及药物使用、疾病诊疗等内容仅供医学专业人士参考。

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编辑：Michel.米萱

校对：MiLu.米鹭

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