腹腔手术后医院内下呼吸道感染分析

目的分析腹腔手术后患者医院内下呼吸道感染的常见病原菌及药物敏感情况。方法回顾性分析2002年1月~2007年1月246例腹腔手术后下呼吸道感染患者的痰菌培养结果。结果246例住院患者分离出261株病原菌,其中革兰氏阴性杆菌183株(70.1%),主要为铜绿假单胞菌、流感嗜血杆菌、不动杆菌、副流感嗜血杆菌和克雷伯菌;革兰阳性球菌60株(23.0%),主要为表皮葡萄球菌、肺炎链球菌及金黄色葡萄球;真菌18株(6.8%)。铜绿假单胞菌、不动杆菌、克雷伯菌对美洛培南、舒普深、头孢吡肟敏感;葡萄球菌对万古霉素均敏感;肺炎链球菌对美洛培南、左氟沙星敏感率高,对青霉素大部分耐药。结论下呼吸道感染以革兰氏阴性杆菌感染为主,且常见病原菌耐药性明显,应根据药敏试验规范使用抗生素,减少耐药菌的产生。     

下呼吸道感染的病原菌分布与耐药性分析

目的：分析临床下呼吸道感染病原菌构成及耐药情况,以指导临床医师合理应用抗菌药物.方法：分析2008年1月-2012年12月解放军总医院第一附属医院从痰（19 365份）、支气管灌洗液（4 203份）以及支气管肺泡灌洗液（302份）标本分离细菌的鉴定及药敏试验结果.结果：共分离出非重复病原菌10 635株,其中革兰阴性杆菌5 244株（49.3%）,革兰阳性球菌2 495株（23.5%）,真菌2 896株（27.2%）.未发现葡萄球菌属对万古霉素、替考拉宁和利奈唑胺的耐药菌株,发现3株大肠埃希菌和32株肺炎克雷伯菌对碳青霉烯类耐药菌株（CRE）,多重耐药铜绿假单胞菌（MDRPA）和鲍曼不动杆菌（MDRAB）分别占14.2%和46.3%.真菌以白色念珠菌为主,对抗真菌药较敏感.结论：下呼吸道感染分离的病原菌中鲍曼不动杆菌、铜绿假单胞菌和金黄色葡萄球菌是主要病原菌,同时耐碳青霉烯类的肠杆菌科细菌（CRE）以及耐万古霉素的肠球菌属（VRE）也是临床抗感染治疗的难点.     

血培养病原菌分布及耐药性分析

目的分析医院血流感染病原菌的分布特点和耐药情况,为临床预防和控制感染提供依据。方法回顾性分析2011年6月至2014年6月本院临床血培养标本中病原菌的感染特点及其药敏。采用BD BACTEC 9120血培养仪进行血培养,BD Phoenix 100全自动细菌鉴定/药敏分析系统对菌株进行鉴定和药敏试验,真菌药敏采用K-B纸片法,用WHONET 5.6软件进行数据分析。结果 9 116例血培养标本中共检出病原菌896株,阳性检出率为9.8%,其中革兰阴性杆菌491株,革兰阳性球菌350株,真菌37株,厌氧菌9株以及革兰阳性杆菌9株;大肠埃希菌和肺炎克雷伯菌对亚胺培南、美罗培南和头孢哌酮/舒巴坦敏感率较高,大肠埃希菌和肺炎克雷伯菌产ESBLs菌株分别为49.5%和38.5%;鲍曼不动杆菌的耐药率高于铜绿假单胞菌,多重耐药和泛耐药鲍曼不动杆菌的检出率分别为32.6%和20.9%,多重耐药铜绿假单胞菌的检出率为18.4%;耐甲氧西林金黄色葡萄球菌和耐甲氧西林凝固酶阴性葡萄球菌的检出率分别为44.4%和70.4%;未发现耐万古霉素、替考拉宁和利奈唑胺的葡萄球菌和肠球菌;粪肠球菌对抗菌药物的耐药率显著低于屎肠球菌。结论本院血流感染病原菌以肠杆菌科细菌为主,凝固酶阴性葡萄球菌感染不容忽视。临床应高度重视早期血培养,合理使用抗菌药物,有效减少耐药菌株的产生。     

手外科患者伤口分泌物的病原菌分布及耐药性分析

目的：对本院手外科患者伤口分泌物中病原菌的分布及其耐药性进行研究分析,为临床用药提供有利依据。方法对2012年1月—2013年5月本院手外科患者伤口分泌物的病原菌进行鉴定及药敏检测。结果本组823份伤口分泌物标本中分离培养出致病菌542份,阳性率为66%,共检测出致病菌株602株,其中包括一份标本有两种以上致病菌株。其中革兰氏阴性杆菌374株,占62%,革兰氏阳性球菌187株,占31%,真菌41株,占7%。革兰氏阴性杆菌前几位为大肠埃希菌、铜绿假单胞菌、鲍曼不动杆菌、阴沟肠杆菌;革兰氏阳性球菌以金黄色葡萄球菌为主。45%的大肠埃希菌产超广谱β-内酰胺酶（ESBLs）,对很多抗生素耐药。28%的金黄色葡萄球菌为耐甲氧西林菌株,没有耐万古霉素的金黄色葡萄球菌株。结论本院手外科患者伤口分泌物标本中以革兰氏阴性杆菌为主,耐药问题比较严重,应对抗生素的合理应用给予足够的重视。     

COPD下呼吸道病原菌感染及耐药性分析

目的 了解慢性阻塞性肺病（COPD）急性发作患者下呼吸道病原菌及药敏情况。方法 对125例COPD患者的痰培养及药敏结果进行分析。结果 从125例COPD患者的痰标本中分离出86株细菌，革兰阴性菌占76.7%，其中铜绿假单胞菌占26.7%。大肠埃希菌占15.1%，克雷伯杆菌占11.6%，药敏分析发现；革兰阴性杆菌耐药率依次为丁胺卡那12.2%，哌拉西林20.7%，头孢他啶22.7%，对氨苄西林耐药率为90.45%，铜绿假单胞菌对哌拉西林敏感，结论 COPD患者下呼吸道感染病原菌以革兰阴性杆菌为主，应根据药敏结果合理选用抗菌的物。     

急性坏死性胰腺炎合并感染的病原菌及耐药性分析

目的：研究急性坏死性胰腺炎（ANP）合并感染的病原菌分布及耐药性,并探讨其对ANP患者预后的影响。 方法：回顾性分析2010年10月—2014年10月收治的72例有明确病原学依据的ANP合并感染患者的临床资料。 结果： 72例ANP患者中,腹腔及腹膜后感染47例（65.28%）,呼吸道感染37例（51.39%）,血流感染32例（44.44%）,其中血流感染与患者死亡密切相关（P<0.05）。检出病原菌235株,其中革兰阴性细菌159株（67.66%）,革兰阳性细菌60株（25.53%）,真菌16株（6.81%）。获得的病原菌中排名前6位的依次是：鲍曼不动杆菌（24.68%）,铜绿假单胞菌（8.94%）,肺炎克雷伯菌（8.09%）,屎肠球菌/粪肠球菌（8.09%）,大肠埃希菌（7.66%）,金黄色葡萄球菌（4.68%）。耐药性分析显示,鲍曼不动杆菌和铜绿假单胞菌对亚胺培南耐药率分别达95.92%和52.63%,对头孢哌酮/舒巴坦的耐药率分别为59.26%和50.00%。肺炎克雷伯菌和大肠埃希菌产超广谱β-内酰胺酶（ESBLs）检出率分别为64.29%和80.00%,对头孢哌酮/舒巴坦的耐药率分别为31.58%和18.75%,而对亚胺培南的耐药率分别为23.08%和7.14%。19株屎肠球菌/粪肠球菌中仅1株对万古霉素耐药,对利奈唑烷尚未发现耐药菌株。耐甲氧西林金黄色葡萄球菌检出率为72.73%,对万古霉素、利奈唑烷和呋喃妥因尚未发现耐药菌株。16株真菌对常用抗真菌药物均未发现耐药菌株。 结论：血流感染是ANP患者死亡的重要原因。ANP患者的病原菌仍以革兰阴性菌为主,但革兰阳性菌和真菌的比例不容忽视。多重耐药菌已成为ANP合并感染的巨大的挑战。     

ICU内中心静脉导管相关性血流感染病原菌耐药性分析

目的：了解ICU内中心静脉导管相关性血流感染（CRBSI）病原菌的分布特点及其耐药性,以指导临床合理用药。方法：回顾性分析2009年1月至2011年12月ICU内CRBSI患者病原菌分布和药物敏感试验资料,比较排位前7位细菌的耐药特征。结果：67例CRBSI患者共检出81株病原菌,其中革兰阳性（G＇）菌40株,占49.2%;革兰阴性（G^-）菌38株,占46.9%;真菌3株,占3.7%,引起CRBSI的主要病原菌依次为凝固菌阴性葡萄球菌（27株,33.3%）,鲍曼不动杆菌（12株,14.8%）,肺炎克雷伯菌（9株,11.1%）,金黄色葡萄球菌（8株,9.9%）,铜绿假单胞菌（7株,8.6%）,大肠埃希菌（6株,7.4%）,G^＋菌中对碳青霉烯菌类最为敏感。结论：近3年来ICU内CRBSI患者病原菌以表皮葡萄球菌及鲍曼不动杆菌为主,并且鲍曼不动杆菌耐药率较高。     

肝移植术后胆汁培养中的病原菌分布及耐药表型分析

目的 对肝移植受者术后胆汁培养中的病原菌分布和耐药表型进行分析,为肝移植术后病原菌感染的临床预防和治疗提供参考.方法 对274例肝移植受者术后胆汁标本的培养结果以及病原菌的药敏试验进行综合分析.结果 274例胆汁标本培养结果显示,有195例标本的病原菌检验呈阳性,阳性率71.2%.共检出病原菌269株,其中阳性球菌168株,以肠球菌(117株)及凝固酶阴性葡萄球菌(50 株)为主;阴性杆菌99株,以铜绿假单胞菌、不动杆菌和嗜麦芽窄食单胞菌为主;检出烟曲霉菌2株.无论阳性球菌还是阴性杆菌,都具有严重的多重耐药性.结论 肝移植受者术后胆汁培养中病原菌的检出率高,耐药性强,耐药范围广.     

烧伤病区病原菌分布及其耐药性调查

目的了解烧伤病区病原菌分布特点及其耐药情况，为临床治疗提供参考。方法回顾性分析笔者单位烧伤病区348例住院患者的创面、血液、静脉导管、痰液、尿液及脓液等标本分离而得的菌株，统计其病原菌分布情况及耐药性。结果共检出464株病原菌，其中革兰阴性杆菌244株占52、6％、革兰阳性球菌188株占40．5％、真菌32株占6．9％。主要检出菌株为金黄色葡萄球菌、铜绿假单胞菌、鲍氏不动杆菌、大肠埃希菌。甲氧西林耐药金黄色葡萄球菌（MRSA）对环丙沙星、青霉素G、苯唑西林等的耐药率已达100、0％，只对万古霉素敏感。铜绿假单胞菌对头孢哌酮／舒巴坦、亚胺培南、头孢吡肟的耐药率分别为15、8％、36、8％、33、3％。结论金黄色葡萄球菌、铜绿假单胞菌、鲍氏不动杆菌、大肠埃希菌是烧伤病区感染的主要病原菌；金黄色葡萄球菌、鲍氏不动杆菌对抗生素的耐药率较高。     

胆道感染240例胆汁细菌培养结果及药敏分析

目的了解引起胆道感染的主要病原菌及其对药物的耐药性。方法对我院自2007年1月至2008年12月收治的240例胆道感染病人术中取胆汁进行细菌培养及药敏分析。结果240份胆汁标本中130份培养阳性,培养阳性率为54.2%。共分离出细菌150株,其中革兰阴性杆菌95株,革兰阳性球菌55株。引起胆道感染的主要病原菌依次为铜绿假单胞菌(26.7%)、大肠埃希菌(18.7%)、肠球菌(14.6%)和克雷伯菌(10.0%)。药敏结果显示,革兰阴性杆菌对亚胺培南、美罗培南、头孢吡肟及阿米卡星(丁胺卡那霉素)耐药率较低;革兰阳性球菌对万古霉素、替考拉宁、阿米卡星及头孢哌酮耐药率较低。结论胆道感染仍以革兰阴性杆菌为主,其中铜绿假单胞菌位居首位;阿米卡星可作为治疗胆道感染的首选用药之一。     

气体中毒患者机械通气后肺部感染病原菌监测和分子流行病学调查

目的分析急性刺激性和窒息性气体中毒患者机械通气后肺部感染病原菌及其药物敏感性和克隆传播情况。方法动态采集15例气体中毒患者机械通气后下呼吸道、呼吸机管路、医护工作人员手拭子及纤维支气管镜样本,常规方法分离病原菌。对分离率较高的病原菌进行药物敏感性试验和脉冲场凝胶电泳（PFGE）分子分型。结果患者下呼吸道平均分离病原菌3．86种,分离率较高的为嗜麦芽窄食单胞菌、粪肠球菌、鲍曼不动杆菌、表皮葡萄球菌和白假丝酵母菌等。分离率最高的嗜麦芽窄食单胞菌对大多数常用抗菌药物的耐药率都在60％以上,且来自患者的菌株与来自工作人员手拭子和纤维支气管镜的菌株PFGE分型一致。结论急性刺激性和窒息性气体中毒机械通气患者下呼吸道存在较严重的多药耐药复合菌感染,且病原菌在不同患者间存在克隆传播。     

Chlamydia pneumoniae respiratory infection after allogeneic stem cell transplantation

Chlamydia pneumoniae is a common cause of upper and lower respiratory tract infections in immunocompetent patients; however, its role as a respiratory pathogen in immunocompromised hosts has been infrequently recognized. We describe C. pneumoniae lower respiratory tract infection in a 19-year-old male after allogeneic stem cell transplantation. The patient developed fever on day +14, and a subsequent computed tomography scan of the chest revealed a right lateral pleural-based opacity, which was then resected during thoracoscopy. Diagnosis was made by culture and staining of the resected tissue with C. pneumoniae-specific monoclonal antibodies, and azithromycin was administered. To the best of our knowledge, this is the first report of C. pneumoniae respiratory infection after stem cell or marrow transplantation. C. pneumoniae often coexists with other etiologic agents of pneumonia in immunocompromised patients. Considering the infrequency of infections from this organism in this clinical setting, one must still rule out other more likely respiratory pathogens.     

Parainfluenza 3 Infections Early After Kidney or Simultaneous Pancreas–Kidney Transplantation

Parainfluenza virus (PIV) can cause serious infections after hematopoietic stem cell or lung transplantation. Limited data exist about PIV infections after kidney transplantation. We describe an outbreak of PIV‐3 in a transplant unit. During the outbreak, 45 patients were treated on the ward for postoperative care after kidney or simultaneous pancreas–kidney (SPK) transplantation. Overall, 29 patients were tested for respiratory viruses (12 patients with respiratory symptoms, 17 asymptomatic exposed patients) from nasopharyngeal swabs using polymerase chain reaction. PIV‐3 infection was confirmed in 12 patients. One patient remained asymptomatic. In others, symptoms were mostly mild upper respiratory tract symptoms and subsided within a few days with symptomatic treatment. Two patients suffered from lower respiratory tract symptoms (dyspnea, hypoxemia, pulmonary infiltrates in chest computed tomography) and required supplemental oxygen. Four of six SPK patients and eight of 39 of kidney transplant patients were infected with PIV (p = 0.04). In patients with follow‐up tests, PIV‐3 shedding was still detected 11–16 days after diagnosis. Despite rapid isolation of symptomatic patients, PIV‐3 findings were diagnosed within 24 days, and the outbreak ceased only after closing the transplant ward temporarily. In conclusion, PIV‐3 infections early after kidney or SPK transplantation were mostly mild. PIV‐3 easily infected immunosuppressed transplant recipients, with prolonged viral shedding.     

Long-term complaints after minimal invasive thoracic surgery operations and thoracotomy]

BACKGROUND: Minimally invasive techniques are now frequently used in general thoracic surgery. More than 30% of all minimally invasive procedures are operations in patients with spontaneous pneumothorax. Recently, it has been shown that the video-assisted approach compared to the standard anterolateral thoracotomy results in a significant reduction of the early postoperative pain. However, little is known about the influence of video-assisted surgery on long-term complaints. METHODS: We analyzed the frequency and characteristics of chronic complaints in 60 patients after video-assisted operations for spontaneous pneumothorax using a standardized questionnaire. For comparison, 27 patients after anterolateral thoracotomy for benign diseases were interviewed 24 months postoperatively using the same questionnaire. RESULTS: After minimally invasive surgery and a median observation time of 59 months, 19 (31.7%) out of 60 patients suffered from chronic complaints. Two of them (3.3%) required daily oral pain medication. On a visual analog pain scale (ranging from 0 to 100), 17 patients described a pain intensity of < 20 and 2 (3.3%) patients > 50. After thoracotomy 14 (51.8%) out of 27 patients suffered from chronic complaints, 5 (18.5%) of them with regular use of oral pain medications. The mean pain intensity (analog scale) was 3.6 points after minimally invasive operations and 14.4 points after thoracotomy (P = 0.01). CONCLUSIONS: In conclusion, even after minimally invasive thoracic operations some patients suffer from chronic complaints. However, they are less frequent and of lower intensity than after thoracotomy.     

Preoperative analgesia management with rofecoxib in thoracotomy patients

OBJECTIVE: Pain management after thoracotomy is significant because pain reduces the postoperative respiratory performance. In this study, the analgesic efficacy and safety of rofecoxib in thoracotomy patients were evaluated. DESIGN: A prospective, randomized, double-blind, and placebo-controlled study. SETTING: This study was performed in the Meram Medical School of Selcuk University Departments of Cardiovascular Surgery and Anesthesiology. PARTICIPANTS: Sixty patients undergoing elective thoracic surgery via thoracotomy were randomized to receive either oral placebo or rofecoxib, 50 mg, 1 hour before surgery. INTERVENTIONS: All patients received a standard anesthetic. Pain scores, sedation scores, heart rate, mean arterial pressure, respiratory rate, analgesic requirements, and side effects were noted 2, 4, 8, 12, 18, 24, 32, 40, and 48 hours after operation. MEASUREMENTS AND MAIN RESULTS: There were no significant differences between the 2 study groups with respect to demographics, sedation score, intraoperative blood loss, and postoperative drainage. Compared with placebo, morphine consumption and pain scores at rest and during coughing were significantly lower with rofecoxib. CONCLUSIONS: The preoperative administration of rofecoxib, 50 mg, provides significant analgesia for postoperative pain relief and decreases additional opioid requirements after thoracotomy.     

A study of postoperative respiratory function]

The purpose of this study is to investigate the causes of postoperative respiratory failure from the point of view of respiratory movement and respiratory function, using a respigraph. Thirty patients who had laparotomy, thoracotomy or both were studied. A-aDo2 increased after operation. The values recovered slowly in the order of thoracotomy, laparotomy, was thoraco-laparotomy group. Percent vital capacity (% VC), one second timed force expiratory volume (FEV1), and peak expiratory flow (PEF) were suppressed immediately after operations and increased slowly, but showed still lower values even on the 7th day. VT, V min, f, TI/TT, VT/TI and PaCO2 were almost at the same levels among the three groups. Percent rib cage (% of RC) increased and remained high on the 7th day after laparotomy and thoraco-laparotomy, but showed no remarkable changes after thoracotomy. Between A-aDo2 and % RC in laparotomy group, there was a good correlation. Not only FRC but also the change of % RC seemed to have caused postoperative hypoxemia. The movement of the abdomen affected respiratory dysfunction more than the movement of the thorax after thoracic and abdominal surgery.     

Lateral Thoracotomy and One-Lung Anesthesia in Patients with Morbid Obesity

Between May, 1980, and October, 1981, 22 morbidly obese patients ranging in weight from 93.4 to 236.8 kg (average, 145.2 kg) underwent transthoracic gastric stapling. Fourteen of these operations were performed using endobronchial intubation and selective collapse of the left lung to facilitate surgical exposure. The patients were compared with 22 consecutive patients treated by transabdominal gastric stapling during the same period. None of the 44 patients had evidence of chronic alveolar hypoventilation (pickwickian syndrome). In terms of operating time, blood loss, duration of intubation, and hospital stay, the two groups did not differ significantly. Despite marked shunting during one-lung ventilation, satisfactory arterial oxygen tension (PaO₂) could be demonstrated on 100% oxygen for all thoracotomy patients (PaO₂ range, 67 to 230 torr; mean, 132.3 torr). In fact, except for a lower PaO₂ during one-lung anesthesia, the thoracotomy patients were indistinguishable from the laparotomy patients in terms of perioperative respiratory function. Pain, sedation, and positioning led to significant decreases in vital capacity and one-second forced expiratory volume in both groups on the first postoperative day, and in the thoracotomy group on the second day. There were only two wound infections in the thoracotomy group, as opposed to six infections with two dehiscences in the laparotomy group. It is concluded that lateral thoracotomy with or without one-lung anesthesia can be performed safely in massively obese patients—at least in those without preexisting alveolar hypoventilation syndrome.     

Sources of pathogens causing pleuropulmonary infections after lung cancer resection.

OBJECTIVE: The source of pathogens responsible for pleuropulmonary complications after lung resection is not yet completely understood, yet knowing this source is very important for proper perioperative use of antibiotics in lung surgery. We studied prospectively the value of sputum samples -- collected 3 days before and 3 days after surgery -- and of intraoperative bronchial swabs in the diagnosis of infective pulmonary complications following lung cancer resection. METHODS: In a prospective trial, we studied 194 patients (18 women and 176 men, age range 34-79 years, mean 57 years) who were operated on for lung cancer. The infection screen consisted of intraoperative bronchial swabs, and sputum samples obtained prior to and 3 days after surgery. Before the operation, all patients were free of clinical signs of respiratory infection. In patients with postoperative infection, causative pathogens were identified from sputum, tracheal aspirate, thoracic puncture and thoracic drainage fluids. RESULTS: Thirty-four patients suffered from 32 pleuropulmonary infections, and two from wound infection. Pathogenic organisms were isolated from preoperative and postoperative sputum samples and from intraoperative bronchial swabs in 50, 64 and 27% of patients, respectively. Postoperative infective complications were caused by gram-negative bacteria and Candida albicans in 75% of patients. These potential pathogens were recovered from preoperative sputum samples and from intraoperative bronchial swabs in only 18 and 13% of cases, but from postoperative sputum samples in 63% of cases. A strong correlation in identified pathogens was found between the postoperative sputum samples and the samples collected for microbiological diagnosis of subsequent postoperative infective complications (P<0.01). CONCLUSIONS: Our results indicate that pathogens that cause pleuropulmonary infective complications are probably acquired postoperatively from the patient's oral cavity, pharynx and hypopharynx. Appropriate antibiotic prophylaxis is discussed.     

A comparison of the analgesic and respiratory effects of epidural nalbuphine or morphine in postthoracotomy patients

This randomized, double-blind study compared the analgesic and respiratory effects of lumbar epidural morphine 5 mg, nalbuphine 10 mg, and nalbuphine 20 mg in repeated doses in patients after thoracotomy; the first dose was administered intraoperatively. Pre-and postoperative monitoring included continuous pulse oximetry, respiratory inductance plethysmography, and repeated arterial blood gas analysis. Postoperatively, visual analogue pain scores, somnolence scores, respiratory rate, and arterial blood gases were determined for 16 h. Preoperatively, episodes of apnea were common during sleep but were not associated with low hemoglobin oxygen saturation or increased arterial carbon dioxide tension (PaCO2). During sleep, some otherwise normal patients had increased PaCO2, and 2 of 15 patients had episodes of hemoglobin oxygen saturation of less than 90%. Postoperatively, 1 and 2 h after arrival in the recovery room, patients who received morphine had lower pain scores than did those who received nalbuphine 10 or 20 mg (P less than 0.05). All 6 patients who received morphine had satisfactory analgesia. Two of 4 patients who received nalbuphine 10 mg and all 5 who received nalbuphine 20 mg were withdrawn from the study because of inadequate analgesia (morphine vs. nalbuphine 10 mg, not significant; morphine vs. nalbuphine 20 mg, P less than 0.01). Two patients who received morphine had persistently increased PaCO2 postoperatively. Two patients who received morphine had episodes of apnea and slow respiratory rate, which were most frequent 6 h after arrival in the recovery room. We conclude that lumbar epidural nalbuphine does not provide adequate analgesia after thoracotomy.(ABSTRACT TRUNCATED AT 250 WORDS)     

老年重症开胸手术围术期呼吸循环变化与呼吸并发症的相关性

目的 探讨老年病人术后呼吸并发症的发生原因及预防策略.方法 对58例高龄或重要脏器有合并症,及行大手术的老年重症开胸手术病人（组1）进行围术期呼吸、循环监测,记录脱氧动脉血气、出入液量、尿比重、漂浮导管血流动力学指标,并与56例非老年病人（组2）进行比较.结果 全组12例呼吸并发症均见于老年重症病人（组1A）,10例为术后早期低氧血症,均始发于术后第2、3 d,另2例为后期感染引起Ⅱ型呼吸衰竭（呼衰）.多因素回归分析示术前呼吸道合并症和肥胖是老年病人术后发生呼吸并发症的独立预测因素.组1A术后前3 d PaO2显著低于未发生呼吸异常的老年病人（组1B）及组2,组1A与组1B术后PaCO2变化相似均显著低于组2.三组间术后第1 d液体出入平衡差异显著,组2为负平衡（-243ml）,组1B为轻度正平衡（＋109ml）,而组1A则为显著的正平衡（＋832ml）,术后前3 d尿比重均显著高于组2.漂浮导管监测发现老年病人术后前3 d心排量上升、外周血管阻力降低表现为循环高动力状态,而肺血管阻力则明显高于术前.结论 老年病人术前呼吸道合并症多见,其是术后易发生呼吸并发症的主要危险因素,呼吸异常是老年重症病人开胸手术后最主要的并发症和死亡原因,手术创伤引起的细胞外液增加所致＂相对性肺水肿＂是造成术后早期容易出现呼吸失代偿的内在因素.减轻创伤应激和严格输液管理可能有助于预防呼吸并发症的发生,密切监护老年病人的呼吸循环指标、尤其是脱氧动脉血气分析以及尿量、尿比重变化趋势,有助于及早发现呼吸异常并及时介入处理以避免发展成为呼吸衰竭.