心脏瓣膜置换术后肺部感染影响因素及心肌酶谱的变化  

Influencing factors for postoperative pulmonary infection in cardiac valve replacement patients and changes of myocardial enzymes

作　　者：魏润生[1] 高海涛[1] 齐贺文[1] 陈晓伟 闫醒军[1] 王利会[1] WEI Run-sheng;GAO Hai-tao;QI He-wen;CHEN Xiao-wei;YAN Xing-jun;WANG Li-hui(Tangshan Gongren Hospital,Tangshan,Hebei 063000,China)

机构地区：[1]唐山工人医院心血管外二科

出　　处：《中华医院感染学杂志》2019年第21期3266-3269,3274,共5页Chinese Journal of Nosocomiology

基　　金：河北省卫生和计划生育委员会基金资助项目(20170621)

摘　　要：目的探讨心脏瓣膜置换术后肺部感染影响因素并监测感染后心肌酶谱变化。方法选择2013年3月-2018年1月在唐山工人医院行心脏瓣膜置换术患者517例,分析术后肺部感染发生率及病原学特点,比较肺部感染影响因素及心肌酶谱变化。结果517例心脏瓣膜置换术后肺部感染68例(13.15%),共分离病原菌79株,其中革兰阴性菌47株(59.49%)、革兰阳性菌22株(27.85%)、真菌10株(12.66%)。感染组与非感染组左心射血分数(LVEF)、呼吸机使用时间、胸骨哆开率、低心排综合征发生率以及再次开胸止血率比较,差异有统计学意义(P<0.05)。经单因素及多因素Logistic回归分析,吸烟、合并基础性疾病是心脏瓣膜置换术后肺部感染独立影响因素(P<0.05)。感染组心肌酶谱各指标均高于非感染组(P<0.05)。结论心脏瓣膜置换术后肺部感染发生率较高,病原菌以革兰阴性菌为主,吸烟史及合并基础性疾病是术后肺部感染独立影响因素,术后肺部感染可引起心肌功能降低。OBJECTIVE To explore the influencing factors for postoperative pulmonary infection in the cardiac valve replacement patients and observe the changes of myocardial enzymes.METHODS A total of 517 patients who received cardiac valve replacement in Tangshan Gongren Hospital from Mar 2013 to Jan 2018 were enrolled in the study,the incidence of postoperative pulmonary infection and etiological characteristics were observed,and the related factors for the pulmonary infection and myocardial enzymes were compared.RESULTS Of the 517 cardiac valve replacement patients,68(13.15%)had postoperative pulmonary infection.Totally 79 strains of pathogens were isolated,47(59.49%)of which were gram-negative bacteria,22(27.85%)were gran-positive bacteria,and 10(12.66%)were fungi.There were significant differences in left ventricular ejection fraction(LVEF),duration of use of ventilator,incidence of sternal duodenum,incidence of low cardiac output syndrome and rate of reoperation for hemostasis between the infection group and the non-infection group(P<0.05).The univariate analysis and multivariate logistic regression analysis showed that smoking history and complication with underlying diseases were the independent risk factors for the postoperative pulmonary infection in the cardiac valve replacement patients(P<0.05).The levels of myocardial enzymes of the infection group were significantly higher than those of the non-infection group(P<0.05).CONCLUSION The incidence rate of postoperative pulmonary infection is high among the cardiac valve replacement patients.The gram-negative bacteria are dominant among the pathogens.Smoking history and complication with underlying disease are the independent risk factors for the postoperative pulmonary infection.The postoperative pulmonary infection may result in the decrease of myocardial function.

关 键 词：心脏瓣膜置换术 肺部感染 病原学 影响因素 心肌酶谱 

分 类 号：R1[医药卫生—公共卫生与预防医学] R4