聚维酮碘口腔预处理对全麻下老年脊柱手术患者口咽部病原菌和下呼吸道感染的影响

杨玉春; 胡玉萍; 张加永; 张莹; 孙帆; 田振

doi:10.11659/jjssx.12E022007

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聚维酮碘口腔预处理对全麻下老年脊柱手术患者口咽部病原菌和下呼吸道感染的影响

临床研究 | 更新时间：2023-05-26

- 聚维酮碘口腔预处理对全麻下老年脊柱手术患者口咽部病原菌和下呼吸道感染的影响
- Effect of oral pretreatment with povidone iodine on oropharyngeal pathogens and lower respiratory tract infection on elderly spinal surgery under general anesthesia
- 局解手术学杂志 2023年32卷第5期页码：421-423
- 作者机构：
  
  1.南京医科大学第四附属医院麻醉科，江苏南京 210031
  2.南京医科大学第四附属医院骨科，江苏南京 210031
  3.南京鼓楼医院集团宿迁医院麻醉科，江苏宿迁 223800
- 作者简介：
  
  田振，E-mail：tianzhen1000@126.com
- 基金信息：
  
  南京市卫生科技发展项目(YKK20250)
- DOI：10.11659/jjssx.12E022007
  中图分类号： R187;R681
- 纸质出版日期：2023-05-25，
  
  收稿日期：2022-12-01，
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杨玉春,胡玉萍,张加永等.聚维酮碘口腔预处理对全麻下老年脊柱手术患者口咽部病原菌和下呼吸道感染的影响[J].局解手术学杂志,2023,32(05):421-423.

YANG Yu-chun,HU Yu-ping,ZHANG Jia-yong,et al.Effect of oral pretreatment with povidone iodine on oropharyngeal pathogens and lower respiratory tract infection on elderly spinal surgery under general anesthesia[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2023,32(05):421-423.
杨玉春,胡玉萍,张加永等.聚维酮碘口腔预处理对全麻下老年脊柱手术患者口咽部病原菌和下呼吸道感染的影响[J].局解手术学杂志,2023,32(05):421-423. DOI： 10.11659/jjssx.12E022007.

YANG Yu-chun,HU Yu-ping,ZHANG Jia-yong,et al.Effect of oral pretreatment with povidone iodine on oropharyngeal pathogens and lower respiratory tract infection on elderly spinal surgery under general anesthesia[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2023,32(05):421-423. DOI： 10.11659/jjssx.12E022007.

摘要

目的

探讨0.5%聚维酮碘口腔预处理对气管插管全麻下老年脊柱手术患者口咽部病原菌变化和下呼吸道感染的影响。

方法

选取在气管插管全麻下行脊柱手术的264例患者为研究对象，按照单双数将其分为对照组（麻醉前用0.9%生理盐水口腔清洁预处理）和观察组（麻醉前用0.5%聚维酮碘口腔清洁预处理），每组132例。统计2组患者的手术类型、ASA分级、手术部位、气管插管机械通气时间及手术时间等手术和麻醉情况。手术结束时，取2组患者咽拭子、痰液及导管套囊黏附物进行病原菌培养，统计2组病原菌检出及住院期间下呼吸道感染情况。

结果

2组患者的手术类型、ASA分级、手术部位、气管插管机械通气时间及手术时间等手术和麻醉情况比较差异无统计学意义（

0.05）。364例患者中共57例检出病原菌，其中革兰氏阴性菌38例，革兰氏阳性菌18例，真菌1例。对照组患者咽拭子、痰液、导管套囊黏附物病原菌检出率显著高于观察组，差异均有统计学意义（

0.05）。观察组术后下呼吸道感染率为2.27%，低于对照组的9.85%，差异有统计学意义（

0.05）。

结论

在麻醉前使用0.5%聚维酮碘消毒液口腔预处理，能降低气管插管全麻下老年脊柱手术患者口咽部病原菌检出率，减少下呼吸道感染。

Abstract

Objective

To investigate the effect of oral pretreatment with 0.5% povidone iodine on the pathogenic changes of oropharynx and lower respiratory tract infection in elderly patients undergoing spinal surgery under general anesthesia with endotracheal intubation.

Methods

A total of 264 elderly patients who underwent spinal surgery under general anesthesia with endotracheal intubation were selected and divided into the control group (oral cleaning pretreatment with 0.9% normal saline before anesthesia) and observation group (oral cleaning pretreatment with 0.5% povidone iodine before anesthesia)

with 132 cases in each group according to odd-even number method.The surgery type

American Society of Anesthesiologists (ASA) classification

surgery site

mechanical ventilation time of endotracheal intubation and surgery time of the two groups were counted.At the end of the surgery

the adhesions of throat swabs

sputum and endotracheal tube cuff of the two groups were taken for pathogenic culture

and the pathogenic detection and the infection of lower respiratory tract during hospitalization between the two groups were compared.

Results

There was no significant difference in the surgery type

ASA classification

surgery site

mechanical ventilation time of endotracheal intubation or surgery time between the two groups (

0.05).Among 364 patients

57 cases were found pathogens

including 38 cases of gram-negative bacteria

18 cases of gram-positive bacteria and 1 case of fungus.The pathogenic detection rates of the adhesions of throat swabs

sputum and endotracheal tube cuff in the control group were higher than those in the observation group

with statistically significant differences (

0.05).The postoperative infection rate of lower respiratory tract in the observation group was lower than that in the control group (2.27%

vs.

9.85%)

with statistically significant difference (

0.05).

Conclusion

The oral pretreatment with 0.5% povidone iodine disinfectant before anesthesia can decrease the detection rate of pathogens in elderly spinal surgery under general anesthesia with endotracheal intubation

and reduce the infection of lower respiratory tract.

关键词

聚维酮碘气管插管脊柱手术下呼吸道感染革兰氏阴性菌

Keywords

povidone iodineendotracheal intubationspinal surgerylower respiratory tract infectiongram-negative bacteria

references

张波波，李新友，张小卫，等.老年脊柱手术患者术后发生谵妄的危险因素分析［J］.中国矫形外科杂志，2019，27（9）：815-818.doi：10.3977/j.issn.1005-8478.2019.09.10http://dx.doi.org/10.3977/j.issn.1005-8478.2019.09.10.

Kawasaki K，Yamamoto M，Suka Y，et al.Development and validation of a nomogram predicting postoperative pneumonia after major abdominal surgery［J］.Surg Today，2019，49（9）：769-777.doi：10.1007/s00595-019-01796-8http://dx.doi.org/10.1007/s00595-019-01796-8.

张嫚，王洁，陈茹，等.骨科全身麻醉手术后转ICU的老年患者发生呼吸机相关肺炎的影响因素［J］.局解手术学杂志，2021，30（10）：890-893.doi：10.11659/jjssx.04E021066http://dx.doi.org/10.11659/jjssx.04E021066.

谢朝云，闫飞，熊永发，等.脊柱手术住院患者术后肺部感染危险因素logistic回归分析［J］.中国感染控制杂志，2018，17（2）：107-111.doi：10.3969/j.issn.1671-9638.2018.02.004http://dx.doi.org/10.3969/j.issn.1671-9638.2018.02.004.

何汉良，丁秀贤，霍东京.骨科老年气管插管住院患者下呼吸道感染病原菌分布及危险因素分析［J］.中国消毒学杂志，2020，37（10）：778-780.doi：10.11726/j.issn.1001-7658.2020.10.017http://dx.doi.org/10.11726/j.issn.1001-7658.2020.10.017.

邵东平，曾雪英，黄小娜.不同浓度聚维酮碘的抗菌能力及对眼表的影响［J］.眼科新进展，2022，42（1）：49-53.doi：10.13389/j.cnki.rao.2022.0011http://dx.doi.org/10.13389/j.cnki.rao.2022.0011.

孟真，魏兰芬，郑云燕，等.某碘伏与胍类复合消毒剂消毒相关性能研究［J］.中国消毒学杂志，2021，38（2）：84-87.doi：10.11726/j.issn.1001-7658.2021.02.002http://dx.doi.org/10.11726/j.issn.1001-7658.2021.02.002.

邱训斌，王群，伍堂洪，等.聚维酮碘预防气管插管细菌寄殖研究［J］.中国消毒学杂志，2017，34（6）：528-530.doi：10.11726/j.issn.1001-7658.2017.06.010http://dx.doi.org/10.11726/j.issn.1001-7658.2017.06.010.

谯瞧，宋平义，官彬，等.气管插管全身麻醉行腹部手术老年患者肺部感染的危险因素及预测模型构建［J］.重庆医学，2022，51（7）：1167-1171.doi：10.3969/j.issn.1671-8348.2022.07.017http://dx.doi.org/10.3969/j.issn.1671-8348.2022.07.017.

Kelly CJ，Walker RW.Perioperative pulmonary aspiration is infrequent and low risk in pediatric anesthetic practice［J］.Paediatr Anaesth，2015，25（1）：36-43.doi：10.1111/pan.12549http://dx.doi.org/10.1111/pan.12549.

张玲，朱金香，王淼，等.早期气管切开对重型颅脑损伤术后并发肺部感染的影响［J］.局解手术学杂志，2019，28（8）：631-638.doi：10.11659/jjssx.01E019057http://dx.doi.org/10.11659/jjssx.01E019057.

Muscedere J，Dodek P，Keenan S，et al.Comprehensive evidence based clinical practice guidelines for ventilator-associated pneumonia：prevention［J］.J Crit Care，2008，23（1）：126-137.doi：10.1016/j.jcrc.2007.11.014http://dx.doi.org/10.1016/j.jcrc.2007.11.014.

许惠清，姚小英，杨青青，等.ICU患儿下呼吸道感染情况调查［J］.中国妇幼保健，2021，36（18）：4305-4308.doi：10.19829/j.zgfybj.issn.1001-4411.2021.18.052http://dx.doi.org/10.19829/j.zgfybj.issn.1001-4411.2021.18.052.

Acosta S，Bjorck M，Wanhainen A.Negative-pressure wound therapy for prevention and treatment of surgical-siteinfections after vascular surgery［J］.Br J Surg，2017，104（2）：75-84.doi：10.1002/bjs. 10403http://dx.doi.org/10.1002/bjs.10403.

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