老年冠心病冠状动脉搭桥术后肺部感染病原学及其影响因素  

Etiology and influencing factors of pulmonary infection in elderly patients with coronary heart disease after coronary artery bypass grafting

作　　者：邓佩琳[1] 胡振东[2] 吴秦风 李宏艳 DENG Pei-lin;HU Zhen-dong;WU Qin-feng;LI Hong-yan(First Affiliated Hospital of Nanyang Medical College,Nanyang,Henan 473000,China;不详)

机构地区：[1]河南省南阳医学高等专科学校第一附属医院外科,河南南阳473000 [2]河南省南阳医学高等专科学校第一附属医院心脏血管外科中心,河南南阳473000 [3]郑州大学第一附属医院外科,河南郑州450000 [4]河南省南阳医学高等专科学校第一附属医院心脏外科监护室,河南南阳473000

出　　处：《中华医院感染学杂志》2022年第11期1702-1706,共5页Chinese Journal of Nosocomiology

基　　金：河南省科技攻关计划基金资助项目(LHGJ20191120)。

摘　　要：目的探讨老年冠心病冠状动脉搭桥术后肺部感染病原学及其影响因素。方法选取2018年10月-2019年10月南阳医学高等专科学校第一附属医院收治的冠心病患者136例,根据患者是否发生肺部感染,分为感染组64例和未感染组72例。观察患者肺部感染后病原菌分布、药敏结果,分析发生肺部感染的影响因素。结果老年冠心病患者术后肺部感染的发生率为47.06%,以革兰阴性菌感染为主,占63.92%;药敏试验显示主要革兰阴性菌对环丙沙星、米诺环素、头孢哌酮/舒巴坦、亚胺培南等耐药率较低,主要革兰阳性菌对利福平、莫西沙星、万古霉素耐药率较低;患者多表现有发热、肺部啰音、血常规、胸部CT改变;单因素结果显示年龄、手术方式、呼吸机通气时间、左心室射血分数(LVEF)、合并糖尿病与冠心病患者发生肺部感染有关(P<0.05);Logistic多因素回归结果显示69岁及以上、体外循环手术、呼吸机通气24 h及以上、LVEF 50%以下、合并糖尿病是冠心病患者冠状动脉搭桥术术后发生肺部感染的影响因素(P<0.05)。结论老年冠心病患者冠脉搭桥术后肺部感染的发生率较高,以革兰阴性菌感染为主,可出现体温、呼吸音、血常规和胸部影像学改变,年龄、手术方式、呼吸机通气时间、LVEF、合并糖尿病是术后肺部感染的影响因素。OBJECTIVE To investigate the etiology and influencing factors of pulmonary infection in elderly patients with coronary heart disease after coronary artery bypass grafting.METHODS A total of 136 patients with coronary heart disease admitted to the First Affiliated Hospital of Nanyang Medical College from Oct.2018 to Oct.2019 were selected,and were divided into an infection group of 64 cases and an uninfected group of 72 cases according to whether the patients had pulmonary infection.The distribution of pathogenic bacteria and drug susceptibility were observed,and the influencing factors of pulmonary infection were analyzed.RESULTS The incidence of postoperative pulmonary infection in elderly patients with coronary heart disease was 47.06%,and gram-negative bacteria were the main infection,accounting for 63.92%.Drug sensitivity test showed that the main gram-negative bacteria had low resistance rates to ciprofloxacin,minocycline,levofloxacin,cefoperazone/sulbactam and imipenem,and the main gram-positive bacteria had low resistance rates to rifampicin,moxifloxacin and vancomycin.Most patients were manifested with fever,lung rales,blood routine and chest CT changes.Univariate analysis showed that age,surgical method,ventilator ventilation time,left ventricular ejection fraction(LVEF)and diabetes mellitus were associated with pulmonary infection in patients with coronary heart disease(P<0.05).Logistic multivariate regression results showed that 69 years old and above,extracorporeal circulation,ventilator ventilation for 24 h or above,LVEF below 50%and diabetes mellitus were the risk factors for pulmonary infection after coronary artery bypass grafting in patients with coronary heart disease(P<0.05).CONCLUSION The incidence of pulmonary infection after coronary artery bypass grafting in patients with coronary heart disease was high,mainly gram-negative bacteria infection,manifested as changes in body temperature,breath sounds,blood routine and chest imaging changes.Age,surgical method,ventilator ventilation time,LVEF a

关 键 词：冠心病 冠状动脉搭桥术 肺部感染 病原菌 影响因素 

分 类 号：R543.3[医药卫生—心血管疾病]