体外循环心脏术后肺部感染的相关因素分析  

Analysis of related factors of pulmonary infection after extracorporeal circulation

作　　者：王雯丹[1] 潘彬彬 王珊 张胜[1] WANG Wendan;PAN Binbin;WANG Shan;ZHANG Sheng(Department of Critical Care Medicine,Taizhou Hospital of Zhejiang Province,Zhejiang Linhai 317000,China;Department of Anesthesiology,Taizhou Hospital of Zhejiang Province,Zhejiang Linhai 317000,China)

机构地区：[1]浙江省台州医院重症医学科,浙江临海317000 [2]浙江省台州医院麻醉科,浙江临海317000

出　　处：《中国现代医生》2022年第21期28-31,共4页China Modern Doctor

基　　金：浙江省卫生科技计划项目(2017KY163)。

摘　　要：目的分析体外循环心脏术后肺部感染的相关因素。方法回顾性分析2020年1月至2021年3月在浙江省台州医院行体外循环心脏手术的76例患者的临床资料,根据术后是否发生肺部感染分为感染组(n=18)和未感染组(n=58)。记录患者的性别、年龄、原发疾病、手术类型、美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级、心功能分级、体外循环时间、手术时间、呼吸机辅助呼吸时间、吸烟史、术后抑酸剂使用时间及是否合并糖尿病、高血压。单因素和多因素Logistic回归分析探讨体外循环心脏术后肺部感染的相关因素。结果单因素分析结果显示,患者的性别、年龄、原发心脏病、手术类型对术后肺部感染均无明显影响(P>0.05);患者合并糖尿病、有吸烟史、ASA分级Ⅲ~Ⅳ级、术前心功能分级3~4级、手术时间≥3h、体外循环时间≥2h、术后抑酸剂使用时间<7d、呼吸机辅助呼吸时间≥48h的患者术后肺部感染发生率更高(P<0.05)。多因素分析结果显示,ASA分级Ⅲ~Ⅳ级、术前心功能分级3~4级、手术时间≥3h、体外循环时间≥2h、术后呼吸机辅助呼吸时间≥48h,合并糖尿病,有吸烟史均是患者肺部感染的高危因素(OR=4.183、3.408、1.861、1.704、9.061、1.902、2.119),而术后抑酸剂使用时间≥7d是其保护因素(OR=0.157)。结论肺部感染是体外循环心脏术后严重的并发症之一,患者术前的ASA分级、心功能分级、手术时间、体外循环时间、术后呼吸机辅助呼吸时间、合并糖尿病、吸烟史、术后抑酸剂使用时间均可影响术后肺部感染的发生。Objective To analyze the related factors of pulmonary infection after extracorporeal circulation.Methods The clinical data of 76 patients undergoing extracorporeal circulation cardiac surgery in Taizhou Hospital of Zhejiang Province from January 2020 to March 2021 were retrospectively analyzed.According to the incidence of postopera-tive pulmonary infection,they were divided into infection group(n=18)and non-infection group(n=58).The patients'gender,age,primary diseases,types of operation,American Society of Anesthesiologists(ASA)classification,cardiac function classification,bypass time,operation time,breathing time of ventilator assisted breathing,smoking history,and postoperative acid suppressant usage time,and diabetes mellitus,hypertension were recorded.Univariate and multivariate analysis were used to analyze the related factors of pulmonary infection after extracorporeal circulation.Results Univariate analysis showed that gender,age,primary heart disease and type of operation had no significant effect on postoperative pulmonary infection(P>0.05);patients combined with diabetes,smoking history,ASA gradeⅢ-Ⅳ,preoperative cardiac function grade 3-4,operation time≥3h,bypass time≥2h,postoperative acid inhibitor use time<7d,ventilator assisted breathing time≥48h had higher incidence of postoperative pulmonary infection(P<0.05).Multivariate analysis showed that ASA gradeⅢ-Ⅳ,preoperative cardiac function grade 3-4,operation time≥3h,bypass time≥2h,postoperative ventilator assisted breathing time≥48h,combined with diabetes,smoking history were the risk factors of pulmonary infection(OR=4.183,3.408,1.861,1.704,9.061,1.902,2.119),however,the time of acid inhibitor use≥7d was the protective factor(OR=0.157).Conclusion Postoperative pulmonary infection is one of the serious complications in patients undergoing cardiac surgery with extracorporeal circu-lation.Preoperative ASA grade,cardiac function grade,operation time,bypass time,postoperative ventilator assisted breathing time,combined with diabete

关 键 词：体外循环 肺部感染 危险因素 重症医学 

分 类 号：R743.3[医药卫生—神经病学与精神病学]