心脏瓣膜置换术后肺部感染的相关危险因素分析  

Related risk factors for pulmonary infections after heart valve replacement

作　　者：李道麟[1] 董平栓[1] 杜来景[1] 刑适颖[1] 李转珍[1] 尚喜燕[1] 范喜梅[1] 

机构地区：[1]河南科技大学第一附属医院心血管内科,河南洛阳471003

出　　处：《中华医院感染学杂志》2013年第16期3908-3910,共3页Chinese Journal of Nosocomiology

基　　金：河南省科技厅重点科研项目(112102310142)

摘　　要：目的调查分析心脏瓣膜置换术后发生肺部感染的相关危险因素,以降低肺部感染并发症的发生率。方法收集2008年12月-2012年6月350例行心脏瓣膜置换术患者的一般资料、心脏检查、术中及术后情况;采用SPSS13.0统计软件处理,分析以上资料与心脏瓣膜置换术后发生肺部感染的关系,计数资料采用χ2检验,计量资料采用t检验。结果 350例行心脏瓣膜置换术患者术后发生感染36例,感染率为10.28%;其中肺部感染30例,占83.33%;痰液细菌培养出金黄色葡萄球菌、鲍氏不动杆菌各8株,分别各占26.67%;感染组左心室射血分数(LVEF)为(45.34±14.55)%、非感染组为(55.01±16.63)%,呼吸机使用时间感染组为(16.11±7.31)h、非感染组为(11.32±6.56)h,术后再次开胸止血12例、胸骨哆开10例、低心排综合征9例,非感染组分别为18、20、21例,两组各项指标比较差异均有统计学意义(P<0.05)。结论心脏瓣膜置换术后发生肺部感染的相关危险因素包括LVEF、呼吸机使用时间、再次开胸止血、胸骨哆开、低心排综合征。OBJECTIVE To investigate the related risk factors for pulmonary infections after cardiac valve replacement so as to reduce the incidence of pulmonary infections.METHODS The general data of 350patients who underwent the heart valve replacement surgery from Dec 2008to Jun 2012were collected,the heart inspection,intraoperative and postoperative conditions were investigated,then the relationship between the data above and the incidence of postoperative pulmonary infections was analyzed by using SPSS13.0statistical software,with the count data being analyzed by using chi-square test,the measurement data being analyzed by using t-test.RESULTS Of totally 350cases of patients who underwent the heart valve replacement surgery,the postoperative infections occurred in 36cases with the infection rate of 10.28%,among which there were 30（83.33%）cases with pulmonary infections.There were 8（26.67%）strains of Staphylococcus aureus and 8（26.67%）strains of Acinetobacter baumannii cultured from the sputum.The LVEF of the patients with infections was（45.34±14.55）%,significantly lower than（55.01±16.63）% of the patients without infections;the duration of mechanical ventilation of the patients with infections was（16.11±7.31）h,significantly longer than（11.32±6.56）h of the patients without infections.There were 12cases who stopped bleeding through thoracotomy,10cases with sternal dehiscence,and 9cases with low cardiac output syndrome among the patients with infections,which were respectively more than 18cases,20cases,and 21cases of the patients without infection,the difference was significant（P 0.05）.CONCLUSION The related risk factors for the pulmonary infections after the heart valve replacement surgery include the LVEF,time of use of ventilator,re-thoracotomy to hemostasis,sternal dehiscence,and low cardiac output syndrome.

关 键 词：肺部感染 瓣膜置换术 心脏瓣膜 危险因素 

分 类 号：R619.3[医药卫生—外科学]