心脏外科手术后患者医院获得性肺炎的危险因素探讨  

Risk Factors for Nosocomial Pneumonia in Patients Following Cardiac Surgery

作　　者：林小玲[1] 江山平[1] 赵祎莉[2] 张蔚[1] 梁瑞韵[1] 吕志强[1] 

机构地区：[1]中山大学附属第二医院呼吸内科,广东广州510120 [2]中山大学附属第二医院输血科,广东广州510120

出　　处：《中华医院感染学杂志》2009年第18期2416-2418,共3页Chinese Journal of Nosocomiology

摘　　要：目的探讨心脏外科手术患者发生医院获得性肺炎(NP)的危险因素。方法收集1996年1月-2007年8月心脏外科手术患者资料469例,评价肺部感染情况,分为NP组与非NP组,比较两组患者围手术期观察项目的差异性,并进行Logistic回归多因素分析。结果34例(7.2%)患者发生医院获得性肺炎,NP组与非NP组比较结果显示,性别、原发性高血压、吸烟、术前使用抗菌药物、心功能≥3级、ASA≥4级、重新气管插管、气管切开、主动脉内球囊反搏、停留鼻胃管、肠外营养时间≥48h、镇痛药物、意识障碍、年龄、术前白蛋白水平、手术时间、体外循环时间、气管插管时间、机械通气时间、输入RBC、输入血浆量、ICU停留时间等22个因素差异有统计学意义;多因素分析结果显示,原发性高血压、血清白蛋白水平、手术时间、机械通气时间、重新气管插管、气管切开、ICU停留时间等7个因素与手术后患者发生医院获得性肺炎有关。结论合并原发性高血压、血清白蛋白水平较低、手术时间≥4h、机械通气时间≥24h、重新气管插管、气管切开、ICU时间停留时间≥24h均是心脏外科手术后患者发生医院获得性肺炎的危险因素。OBJECTIVE To investigate the risk factors for nosocomial pneumonia in patients following cardiac surgery. METHODS Totally 469 cases were collected from Jan 1996 to Aug 2007. Nosocomial pneumonia was diagnosed by the clinical pulmonary infection score. Twenty-nine variables among patients with nosocomial pneumonia and without nosocomial pneumonia were analyzed by Logistic regression analysis. RESULTS The incidence of nosocomial pneumonia following cardiac surgery was 7. 2% （34/469）. There was significantly different in 22 variables between patients with nosocomial pneumonia and without nosocomial pneumonia and 7 variables were found to be significantly related to the development of nosocomial pneumonia by multivariate analysis： hypertension （OR=3. 691, P=0. 017）, serum albumin 〈40g （OR= 9. 700, P〈0. 001）, the duration of operation ≥ 4 hours （0R=7. 635, P=0. 011）, mechanical ventilation ≥ 24 hours （OR=3. 365, P=0. 037）, reintubation （OR=10. 250, P=0. 001）, tracheotomy （OR=38. 277, P=0. 004）, and ICU stay ≥ 24 hours （OR 5. 389, P= 0.011）. CONCLUSIONS Hypertension, serum albumin〈40g, the duration of operation≥ 4 hours, mechanical ventilation ≥24 hours,reintubation, tracheotomy, and ICU stay ≥ 24 hours are the risk factors for nosocomial pneumonia in patients following cardiac surgery.

关 键 词：心脏外科手术 医院获得性肺炎 危险因素 

分 类 号：R181.32[医药卫生—流行病学]