心脏瓣膜置换术后肺部感染相关因素分析及预防措施  

作　　者：张丽萍[1] 赵顺英[1] 

机构地区：[1]浙江省宁波市医疗中心李惠利医院,315000

出　　处：《浙江临床医学》2020年第6期807-809,共3页Zhejiang Clinical Medical Journal

基　　金：浙江省宁波市自然科学基金(2017A610261)。

摘　　要：目的探讨心脏瓣膜置换术后肺部感染的病原菌分布、感染原因及预防措施。方法回顾性分析本院心脏瓣膜置换术患者246例,通过收集其年龄、性别、吸烟史、基础疾病、术前心超情况、手术时间、呼吸机支持时间等资料。采用单因素和多因素logstic回归分析,探讨分析心脏瓣膜置换术后肺部感染的相关危险因素及预防措施。结果246例心脏瓣膜置换术后患者中,28例发生术后感染,感染率为11.38%,其中发生肺部感染24例,占85.71%。从中分离出病原菌22株,其中革兰氏阴性菌15株,占68.18%,前三位分别为鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌;革兰氏阳性菌2株,占9.09%;真菌5株,占22.73%。单因素分析结果示心脏瓣膜置换术后肺部感染的发生与手术时间、主动脉阻断时间、呼吸机使用时间、术中输红细胞悬液、围术期胺碘酮的使用、术前左心室射血分数(LVEF)、肺动脉高压等危险因素相关(P<0.05)。多因素logistic回归分析示呼吸机使用>1d及肺动脉高压是心脏瓣膜置换术后肺部感染的独立危险因素。结论加强心脏瓣膜置换术患者的围术期管理,有助于有效控制术后肺部感染的发生。Objective To find out the distribution of pathogens,risk factors and prevention of pneumonia after cardiac valve replacement.Methods A total of 246 patients who received the cardiac valve replacement were retrospectively investigated.We collected the age,sex,smoking history,basic diseases,UCG(include LVEDD,LAD,LVEF and PAP),operation time,the duration of intubation and so on.The univariate analysis and multivariate logistic regression analysis were adopted to analyze these factors.Results Among the 246 patients,28 ones had postoperative infection,and the infection rate was 11.38%.24 of them had pneumonia,accounting for 85.71%.In this study,22 strains of pathogenic bacteria were isolated,including 15 strains of gram-negative bacteria(68.18%).Acinetobacter baumannii,Pseudomonas aeruginosa and Klebsiella pneumoniae ranked the top three species of pathogens.Univariate analysis of risk factors for pneumonia after cardiac valve replacement were postoperative low cardiac output syndrome,LVEF,PAP,operation time,the duration of intubation and so on(P<0.05).Multivariate logistic regression analysis showed that the duration of intubation more than one day and the pulmonary hypertension were independent risk factors for pneumonia after cardiac valve replacement.Conclusion Pneumonia after cardiac valve replacement is related to various factors.So we should put forward to enhance the perioperative management so as to effectively control the incidence of postoperative pneumonia and improve the patient's quality of life.

关 键 词：瓣膜置换术后 肺部感染 危险因素 预防 

分 类 号：R54[医药卫生—心血管疾病]