老年经皮冠状动脉介入术后肺部感染预后影响因素  

Prognosis of percutaneous coronary intervention patients with postoperative pulmonary infection and influencing factors

作　　者：吕烨辉 郑淑梅[3] 王海荣[3] 张春来 刘长青 刘学明 LYU Ye-hui;ZHENG Shu-mei;WANG Hai-rong;ZHANG Chun-lai;LIU Chang-qing;LIU Xue-ming(Tangshan Central Hospital,Tangshan,Hebei 063000,China;不详)

机构地区：[1]河北省唐山市中心医院心内科,河北唐山063000 [2]河北省唐山市中心医院护理部,河北唐山063000 [3]河北省唐山市工人医院心内科,河北唐山063000

出　　处：《中华医院感染学杂志》2020年第21期3277-3282,共6页Chinese Journal of Nosocomiology

基　　金：唐山市科技发展计划基金资助项目(161173-5-3)。

摘　　要：目的探究老年经皮冠状动脉介入术(PCI)后肺部感染预后影响因素。方法选择2017年1月-2019年1月于唐山市工人医院行PCI治疗的冠心病患者,将102例PCI术后发生肺部感染的患者纳入感染组,另择100例术后未发生肺部感染的患者作为对照组。收集急性生理学与慢性健康状况(APACHEⅡ)评分、快速序贯器官功能衰竭(qSOFA)评分等资料,测定血清降钙素原(PCT)水平,随访记录28 d存活情况。结果共分离出128株致病菌,其中革兰阴性菌62株(48.44%),革兰阳性菌56株(43.75%),真菌10株(7.81%);感染组血清PCT水平、APACHEⅡ评分、qSOFA评分高于对照组(P<0.05),病死组各指标高于存活组(P<0.05);合并糖尿病、吸烟史、高PCT水平、高APACHEⅡ评分、高qSOFA评分是肺部感染预后不良的独立危险因素(P<0.05);受试者工作特征曲线(ROC)示,血清PCT、APACHEⅡ评分、qSOFA评分预测患者预后的曲线下面积(AUC)分别为0.749、0.853、0.829;APACHEⅡ评分、qSOFA评分分别联合血清PCT及三者联合预测预后的AUC分别为0.858、0.884、0.898。结论老年冠心病PCI术肺部感染患者可伴有血清PCT、APACHEⅡ评分、qSOFA评分的升高,两两联合或多者联合对预后具有更高的预测价值。OBJECTIVE To explore prognosis of percutaneous coronary intervention(PCI)patients with postoperative pulmonary infection and influencing factors.METHODS The patients with CHD who underwent PCI in Tangshan Worker’s Hospital from Jan 2017 to Jan 2019 were enrolled in the study,102 patients who had pulmonary infection after PCI were assigned as the infection group,and 100 patients who did not have pulmonary infection after the surgery were set as the control group.The clinical data such as acute physiology and chronic health evaluation II(APACHE II)score and quick sequential organ failure assessment(qSOFA)score were collected,the serum procalcitonin(PCT)level was measured,and the 28-day survival rates were followed up and recorded.RESULTS A total of 128 strains of pathogens were isolated,62(48.44%)of which were gram-negative bacteria,56(43.75%)were gram-positive bacteria,and 10(7.81%)were fungi.The serum PCT level,APACHE score and qSOFA score of the infection group were significantly higher than those of the control group(P<0.05).The levels of the indexes of the mortality group were significantly higher than those of the survival group(P<0.05).The complication with diabetes mellitus,smoking history,high PCT level,high APACHEⅡscore and high qSOFA score were the independent risk factors for the adverse prognosis of the patients with pulmonary infection(P<0.05).Receiver operator characteristic curve(ROC)curve showed that the areas under curve(AUCs)of the serum PCT,APACHEⅡscore and qSOFA score were respectively 0.749,0.853 and 0.829 in prediction of the prognosis;the AUCs of the APACHEⅡscore,qSOFA score combined with serum PCT and the joint detection of three indexes were respectively 0.858,0.884 and 0.898 in prediction of the prognosis.CONCLUSION The elderly patients with CHD who have pulmonary infection after PCI may be complicated with the rise of serum PCT level,APACHEⅡscore and qSOFA score,and the combination of any two or three indexes has higher value in prediction of the prognosis.

关 键 词：急性生理学与慢性健康状况评分 快速序贯器官功能衰竭评分 降钙素原 经皮冠状动脉介入术 肺部感染 

分 类 号：R473[医药卫生—护理学]