成人心内直视手术后肺部感染病原菌及相关因素分析  

Analysis on pathogens and related factors of pulmonary infection after intracardiac operation under direct vision in adult patients

作　　者：向军[1] 何玲[2] 刘艳[1] 彭泰峦[1] 张凡 魏蜀亮[1] XIANG Jun;HE Ling;LIU Yan;PENG Tailuan;ZHANG Fan;WEI Shuliang(Department of Cardiac Macrovascular Surgery,Affiliated Hospital of North Sichuan Medical College,Nanchong,Sichuan 637000,China;Department of Pediatrics,Affiliated Hospital of North Sichuan Medical College,Nanchong,Sichuan 637000,China)

机构地区：[1]川北医学院附属医院心脏大血管外科,四川南充637000 [2]川北医学院附属医院儿科,四川南充637000

出　　处：《重庆医学》2020年第3期416-420,共5页Chongqing medicine

基　　金：川北医学院校级科研发展项目(CBY16-A-YB20)

摘　　要：目的探讨成人心内直视手术后肺部感染的常见病原菌及相关危险因素。方法回顾性分析2013年11月至2016年7月该院心胸外科412例心内直视手术患者的临床资料,患者均在全身麻醉低温体外循环(CPB)下行心内直视手术,按照术后是否发生肺部感染分为感染组和非感染组,对两组患者的性别、年龄、吸烟指数(SI)、术前合并症、术前心功能、CPB时间、主动脉阻断时间(AOT)、术后机械通气时间(MVT)及并发症发生率进行比较;并通过多因素Logistic回归分析进一步明确肺部感染的危险因素。结果412例患者中,肺部感染49例(11.89%);年龄大于或等于60岁、SI≥400、术前合并糖尿病、慢性阻塞性肺疾病(COPD)Ⅱ级以上、术前心功能Ⅲ级以上、AOT长(≥90 min)、术后MVT长(≥6 h)及术后低心排综合征(LCOS)的患者肺部感染发生率明显增高。结论成人心内直视术后患者肺部感染发生率较高,通过筛选肺部感染的高危因素,制订相应的干预措施,可有效地降低肺部感染发生率。Objective To investigate the common pathogens and related risk factors of pulmonary infection after intracardiac operation under direct vision in adult patients.Methods The clinical data in 412 cases of intracardiac operation under direct vision in general anesthesia hypothermia cardiopulmonary bypass(CPB)in the department of thoracic and cardiovascular surgery of this hospital from November 2013 to July 2016 were retrospectively analyzed.All the cases conducted the intracardiac operation under direct vision in general anesthesia hypothermia CPB.According to whether developing postoperative pulmonary infection,the cases were divided into the infection group and non-infection group.The gender,age,smoking index(SI),preoperative complications,preoperative cardiac function,CPB time,aortic occlusion time(AOT),postoperative respirator assisted time and complications occurrence rate were compared between the two groups.The multivariate Logistic regression analysis was performed to further definitely clear the risk factors of pulmonary infection.Results Among 412 cases,the pulmonary infection was in 49 cases(11.89%),the pulmonary infection occurrence rate in the patients with age≥60 years old,SI≥400,perioperative complicated with diabetes mellitus,gradeⅡCOPD,preoperative cardiac function>gradeⅢ,AOT≥90 min,postoperative mechanical ventilation time(MVT)≥6 h,postoperative low cardiac output syndrome(LCOS)was significantly increased.Conclusion The pulmonary infection incidence rate after intracardiac operation under direct vision in adult patients is high.Screening the high risk factors of pulmonary infection and formulating the corresponding intervention measures can effectively reduce the occurrence rate of pulmonary infection.

关 键 词：心内直视手术 体外循环 肺部感染 危险因素 

分 类 号：R654.2[医药卫生—外科学]