心脏瓣膜置换术患者肺部感染相关因素分析与对策  

Related factors for pulmonary infections in patients undergoing heart valve replacement surgery and countermeasures

作　　者：马玲波 胡振东 彭冉 青红娜 秦金萍 

机构地区：[1]南阳医专第一附属医院心脏外科,河南南阳473000

出　　处：《中华医院感染学杂志》2016年第13期3008-3010,共3页Chinese Journal of Nosocomiology

基　　金：河南省科技厅科技攻关基金资助项目(130029980987)

摘　　要：目的探讨分析心脏瓣膜置换术患者肺部感染的相关因素及对策,以期能够为避免和减少心脏瓣膜置换术患者肺部感染的发生和发展提供参考依据。方法选取2013年2月-2015年1月于医院进行心脏瓣膜置换手术患者297例,将26例发生肺部感染患者为肺部感染组,271例非肺部感染患者为非肺部感染组;调查分析患者肺部感染发生情况、病原菌分布以及相关因素。结果 297例行心脏瓣膜置换术患者中,31例术后发生感染,感染率为10.44%,其中发生肺部感染26例,占83.87%;感染病原菌26株,其中革兰阴性菌19株占73.07%,革兰阳性菌6株占23.08%,真菌1株占3.85%;肺部感染组患者左心射血分数(LVEF)、呼吸机使用时间、再次开胸止血率、胸骨哆开率以及低心排综合征发生率均明显升高,与非肺部感染组患者相比,差异均有统计学意义(P<0.05)。结论通过对病原菌分布及相关因素的调查分析,并采用具有针对性的干预措施,能有效降低心脏瓣膜置换术患者肺部感染的发生。OBJECTIVE To explore the related factors for pulmonary infections in patients undergoing heart valve replacement surgery and put forward the countermeasures so as to reduce the incidence of pulmonary infections in the patients undergoing the heart valve replacement surgery.METHODS A total of 297 patients who underwent the heart valve replacement surgery in the hospital from Feb 2013 to Jan 2015 were enrolled in the study,26 patients with pulmonary infections were assigned as the pulmonary infection group,and 271 patients without pulmonary infections were set as the non-pulmonary infection group.The incidence of pulmonary infections,distribution of pathogens,and related factors were investigated and analyzed.RESULTS Of the 297 patients undergoing the heart valve replacement surgery,31 had postoperative infections with the infection rate 10.44%,of whom 26（83.87%）had pulmonary infections.Totally 26 strains of pathogens causing the pathogens were isolated,including 19（73.07%）strains of gram-negative bacteria,6（23.08%）strains of gram-positive bacteria,and 1（3.85%）strain of fungus.The left ventricular ejection fraction（LVEF）score,time of use of ventilator,rate of thoracotomy for second time of hemostasis,rate of sternal dehiscence,and incidence of low cardiac output syndrome were significently increased in the pulmonary infection group,as compared with the non-pulmonary infection group（P〈0.05）.CONCLUSION It is an effective way to investigate the distribution of the pathogens,analyze the related factors,and take targeted intervention measures so as to reduce the incidence of pulmonary infections in the patients undergoing the heart valve replacement surgery,and improve the curative effect.

关 键 词：心脏瓣膜置换术 肺部感染 因素 对策 

分 类 号：R654.2[医药卫生—外科学]