心脏术后呼吸机相关性事件的发生率、危险因素和对临床结局的影响  

Incidence,risk factors and clinical outcomes of ventilator associated events after cardiac surgery

作　　者：刘顺碧[1] 汤清 辛东[1] 丁盛[1] 张近宝[1] 欧阳辉[1] 何思毅 LIU Shun-bi1 , TANG Qing2, XIN Dong1, DING Sheng1 , ZHANG Jin-bao1 , OU Yang-hui1 , HE Si-yi1(1. Department of Cardiovascular Surgery, Chengdu Military General Hospital, Chengdu 610083, Sichuan, China ; 2. Chengdu Civil Aviation Medical Center, Chengdu 610202, Sichuan, Chin)

机构地区：[1]成都军区总医院心外科,四川成都610083 [2]成都民用航空医学中心,四川成都610202

出　　处：《心脏杂志》2018年第3期322-325,共4页Chinese Heart Journal

摘　　要：目的观察和分析呼吸机相关性事件(ventilator associated event,VAE)的发生率、危险因素和对临床结局的影响。方法收集行体外循环心脏手术的成年患者。VAE诊断标准参考美国疾病控制预防中心提出的定义。分析危险因素和对临床结局的影响时按是否发生VAE分为VAE组(n=45)和非VAE组(n=556)。收集患者的临床信息进行统计分析。结果共纳入601例患者,其中45例符合VAE诊断标准,发生率为7.5%。通过单因素分析及多因素logistic回归分析,我们发现慢性支气管炎、左室射血分数(LVEF)<30%、NYHA心功能IV级、体外循环转流时间、主动脉阻断时间、主动脉内球囊反搏(IABP)置入、急性肾功能不全、再次插管和机械通气时间是VAE的独立危险因素。一旦心脏术后患者出现VAE,其ICU留治时间、总住院日及病死率将会显著高于非VAE患者。结论 VAE在心脏术后患者中发生率较高,危险因素较多,且与不良临床结局息息相关。要针对危险因素进行及早的干预。AIM The present study describes the incidence, risk factors and clinical outcomes of ventilator associated events （VAE） after cardiac surgery. METHODS Postoperative patients were monitored for VAEs. By reviewing electronic medical records and preserved files retrospectively, clinical data were further analyzed. RESULTS A total of 601 adult patients were enrolled, of which 45 episodes met the criteria for VAE. The mean incidence rate reached up to 7.5%. By using both univariate analysis and multiple logistic regression, chronic bronchitis, LVEF 〈 30%, NYHA grade IV, cardiopulmonary bypass time, aortic clamping time, mechanical ventilation time, reintubation, and acute kidney injury were found to independent risk factors for VAEs. Compared with non-VAE group, VAEs were closely related to higher mortality, longer intensive care unit stay time, and hospitalization time. CONCLUSION VAE algorithm is a valid and reliable surveillance for possible infections caused by mechanical ventilation, which could easily occur in patients after cardiac surgery and is associated with poor prognosis. The risk factors identified in this investigation provide potential preventive strategies.

关 键 词：呼吸机相关性事件 心脏术后 危险因素 

分 类 号：R654.2[医药卫生—外科学]