A型主动脉夹层术后呼吸机相关性肺炎危险因素及其风险模型构建  

Risk factors for postoperative ventilator-associated pneumonia in patients undergoing type A aortic dissection and establishment of risk model

作　　者：张丽平[1] 王玉伟[1] 毛雷芳[2] ZHANG Li-ping;WANG Yu-wei;MAO Lei-fang(Henan Chest Hospital,Zhengzhou,Henan 450000,China)

机构地区：[1]河南省胸科医院心外科,河南郑州450000 [2]河南省胸科医院康复科,河南郑州450000

出　　处：《中华医院感染学杂志》2022年第17期2633-2637,共5页Chinese Journal of Nosocomiology

基　　金：河南省医学科技攻关计划联合共建基金资助项目(LHGJ20200222)。

摘　　要：目的探究A型主动脉夹层术后呼吸机相关性肺炎危险因素及其风险模型的构建。方法回顾性分析2018年1月-2020年12月于河南省胸科医院进行A型主动脉夹层术的285例患者的临床资料,依据术后是否出现呼吸机相关性肺炎分为感染组42例和非感染组243例,单因素和多因素Logistic回归分析术后发生呼吸机相关性肺炎的危险因素,并构建风险预测模型。结果多因素Logistic回归分析显示,应用抑酸剂、手术时间≥6 h、术后呼吸衰竭、气管切开插管和混合插管是A型主动脉夹层术后发生呼吸机相关性肺炎的危险因素(P<0.05)。以A型主动脉夹层术后发生呼吸机相关性肺炎的独立危险因素构建的风险预测模型,经Boostrap行内部验证,校正后一致性指数为0.908。结论应用抑酸剂、手术时间≥6 h、术后呼吸衰竭、气管切开插管和混合插管是A型主动脉夹层术后呼吸机相关性肺炎的危险影响因素,通过构建风险模型,实施早期干预,可降低呼吸机相关性肺炎的发生率。OBJECTIVE To explore the risk factors for postoperative ventilator-associated pneumonia(VAP)in patients undergoing type A aortic dissection and the establishment of risk model.METHODS From Jan 2018 to Dec 2020,the clinical data of 285 patients who underwent type A aortic dissection in Henan Chest Hospital were retrospectively analyzed,and the patients were divided into the infection group with 42 cases and the no infection group with 243 cases according to the status of postoperative VAP.Univariate analysis and multivariate logistic regression analysis were performed for the risk factors for the postoperative VAP,and the risk prediction model was established.RESULTS Multivariate logistic regression analysis showed that use of acid suppressor,operation duration no less than 6 hours,postoperative respiratory failure,endotracheal intubation and mixed intubation were the risk factors for the postoperative VAP in the patients undergoing type A aortic dissection(P<0.05).The risk prediction model was established based on the independent risk factors for the postoperative VAP and was verified internally by Boostrap,and the adjusted consistency index was 0.908.CONCLUSION The use of acid suppressor,operation duration no less than 6 hours,postoperative respiratory failure,endotracheal intubation and mixed intubation are the risk factors for the postoperative VAP in the patients undergoing type A aortic dissection.The establishment of risk prediction model and early intervention can reduce the incidence of VAP.

关 键 词：A型主动脉夹层术 呼吸机相关性肺炎 危险因素 列线图 模型构建 早期干预 

分 类 号：R543.1[医药卫生—心血管疾病]