成人体外循环心脏术后呼吸机相关肺炎的危险因素分析  

Risk Factors Analysis of Ventilator-Associated Pneumonia in Adult Patients Undergoing Heart Surgery with Cardiopulmonary Bypass

作　　者：尤颢[1] 廖崇先[1] 杨谦[1] 单忠贵[1] 赵霞[1] 邱风[1] 林智[1] 郭宏伟[1] 朱鹏[1] 

机构地区：[1]厦门大学附属中山医院心脏外科,福建厦门361004

出　　处：《中国呼吸与危重监护杂志》2009年第2期162-165,共4页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的分析成人体外循环心脏术后影响呼吸机相关性肺炎（VAP）发生的危险因素。方法对厦门大学附属中山医院心脏外科重症监护病房（CSICU）2002年1月-2008年6月间收治连续体外循环心脏手术后机械通气超过48h的127例成年患者进行回顾性分析，根据发生VAP与否将其分为VAP组及对照组。对患者的临床资料先进行单因素分析筛选，并将有意义的变量进行多因素回归分析。结果体外循环心脏术后VAP总发病率5．1％，发生VAP患者死亡率为28．1％。单因素分析显示：VAP组体外循环时间、机械通气时间、围手术期血液制品用量、术后CSICU入住天数（P〈0．001）、术后低心排综合征的发生率、气管切开率（P〈0．01），大动脉手术率、术后死亡率（P〈0．05）均高于对照组；术前左室射血分数（LVEF）、术后氧合指数（PaO2／FiO2）低于对照组（P〈0．001）。Logistic多因素回归分析显示：体外循环〉120min（OR=6．352，P=0．000）、术后PaO2／FiO2低于300mmHg（OR=3．642，P=0．017）、血液制品用量≥1500mL（OR=5．083，P=0．039）、机械通气时间≥5d（OR=9．074，P=0．047）、气管切开（OR=19．899，P=0．021）与VAP的发生明显相关。64例VAP患者中共培养出病原菌102株，其中革兰阴性菌62株（60．8％），革兰阳性菌19株（18．6％）；真菌21株（20．6％）。结论心脏手术体外循环时间长、术后低氧血症、大量血液制品应用，长时间机械通气和气管切开是体外循环心脏术后VAP发生的危险因素。Objective To analyze the risk factors for ventilator-associated pneumonia （VAP） in adult patients undergoing cardiac surgery with cardiopulmonary bypass （CPB）. Methods A total of 127 consecutive adult patients who received postoperative ventilation for more than 48 hours between January 2002 and June 2008 in the cardiac surgical intensive care unit （CSICU） were included in this study. The patients were assigned into a VAP group（ n = 64 ） and a control group （n = 63 ）. Pre-, intra-, and postoperative factors were collected and analyzed between two groups, and the multivariate analysis （ logistic regression ） were used to identify the risk factors of VAP. Results The overall incidence of VAP was 5.1%. The mortality of VAP was 28.1%. Compared to the control group, the patients in the VAP group had longer duration of cardiopulmonary bypass time, ventilation time, more blood products usage and the duration of stay in CSICU （P 〈 0. 001 ）, higher morbidity of low cardiac output syndrome and tracheotomy （P 〈 0. 01 ） and higher rate of aortic surgery and mortality （ P 〈 0. 05 ）. The preoperative left ventricular ejection fraction （LVEF） and postoperative oxygenation index（ PaO2/FiO2 ） were lower in the VAP group than those of the control group（ P 〈 0. 001 ）. Five variables were found to be significantly related to the development of VAP by multivariate analysis ： CPB time 〉 120 min （ OR = 6. 352, P = 0. 000） ; PaO2/FiO2 〈 300 mm Hg （ OR = 3. 642, P = 0. 017 ）, transfusion of blood products 〉/1500 mL（ OR = 5. 083, P = 0. 039 ）, ventilation time ≥ 5 days（ OR =9. 074,P =0. 047） and tracheotomy（ OR = 19. 899, P =0. 021 ）. A total of 102 pathogens were obtained by sputum culture in 64 VAP patients. There were 62 （60. 8% ） cases of gram negative bacilli, 19 cases（ 18. 6% ） of gram positive cocci and 21 （20. 6% ） cases of eumycetes. Conclusion This study shows that the eardiopulmonary bypass time, ventilation time, hypoxemia, blood

关 键 词：呼吸机相关性肺炎 心脏手术 体外循环 危险因素 多因素回归分析 

分 类 号：R654.2[医药卫生—外科学] R563.1[医药卫生—临床医学]