气管插管全麻术后患者肺部感染危险因素的Meta分析

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。

Risk factors for pulmonary infection in patients after tracheal intubation under general anesthesia: a Meta analysis

ObjectiveTo systematically assess risk factors for pulmonary infection in patients after tracheal intubation under general anesthesia.MethodsLiteratures published between the establishment of database and September 15, 2017 were retrieved from PubMed, 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 RevMan 5.3 software.ResultsA 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.ConclusionIt 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.