感染性心内膜炎术后肺部感染的危险因素  

Risk Factors of Pulmonary Infection following Cardiac Surgery for Infective Endocarditis

作　　者：黎学明 曾晓东 雷黎明[1] 李嘉欣[1] 吴梅芬 汤黎黎 陈官映 凌云[1] LI Xueming;ZENG Xiaodong;LEI Liming;LI Jiaxin;WU Meifen;TANG Lili;CHEN Guanying;LING Yun(Guangdong Cardiovascular Institute,Guangdong Provincial People's Hospital(Guangdong Academy of Medical Science),Southern Medical University,Guangzhou 510080,China)

机构地区：[1]广东省心血管病研究所南方医科大学附属广东省人民医院(广东省医学科学院),广州510080

出　　处：《岭南心血管病杂志》2023年第5期534-539,545,共7页South China Journal of Cardiovascular Diseases

基　　金：2021年广东省医学科研基金(项目编号:A2021486);2021年广州市科技基础与应用基础研究项目(项目编号:202102080379)。

摘　　要：目的分析感染性心内膜炎(infective endocarditis,IE)术后肺部感染的危险因素。方法选取2019年1月1日至2021年1月31日在广东省人民医院收治的确诊IE患者,根据是否发生术后肺部感染分为肺部感染组与非肺部感染组。肺部感染危险因素的单因素分析采用t检验或秩和检验,单因素分析中P<0.05的变量再进行二分类Logistic回归多因素分析。采用受试者工作特征曲线(receiver operating characteristic curve,ROC)评估模型的精确度。结果共纳入225例患者,非肺部感染组202例,肺部感染组23例,术后肺部感染发生率为10.2%。肺部感染组患者痰培养均阳性,总共培养出24株病原体,细菌15株(62.5%),真菌9株(37.5%)。最常见病原体为铜绿假单胞菌和白念珠菌,均为4株,占16.7%。单因素分析结果示IE术后肺部感染的危险因素包括年龄、原发性高血压(高血压)、脑血管疾病、急性左心力衰竭、赘生物大小、降钙素原、脑钠肽、体外循环时间延长、术后使用主动脉内球囊反搏(intra-aortic balloon pump,IABP)、再次气管插管、术后持续肾替代治疗(continuous renal replacement therapy,CRRT)和机械通气时间延长。Logistic回归多因素分析结果示再次气管插管(OR=257.985)、术后CRRT(OR=125.877)、赘生物大小(OR=1.134)和高血压(OR=7.246)为IE术后肺部感染的独立危险因素(P<0.05)。该模型预测术后肺部感染的危险因素的敏感度为86.96%,特异度为96.04%,精确度为93.8%。结论IE术后肺部感染的发生率较高,危险因素多且复杂。其中,再次气管插管、术后CRRT、赘生物大小、高血压是IE术后肺部感染的独立危险因素,临床工作中应采取积极措施来预防和减少术后肺部感染的发生。Objectives To analyze the risk factors of pulmonary infection in patients with infective endocarditis(IE)after cardiac surgery.Methods Patients with IE after cardiac surgery in Guangdong Provincial People's Hospital between January 1,2019 and January 31,2021 were included.The patients were divided into pulmonary infection group and non-pulmonary infection group according to whether postoperative pulmonary infection occurred.The univariate analysis was performed using t test or Wilcoxon rank sum test,and the variables with P<0.05 were then subjected to the multiple Logistic regression.The area under the receiver operating characteristic curve(ROC)was used to evaluate the accuracy of the model.Results A total of 225 patients were included in this study,202 of them in non-pulmonary infection group and 23 of them in pulmonary infection group.The incidence of postoperative pulmonary infection was 10.2%.The sputum cultures in pulmonary infection group were all positive.A total of 24 pathogens were cultured,including 15 bacterial strains(62.5%)and 9 fungal strains(37.5%).The most common pathogens were Pseudomonas aeruginosa and Candida albicans,each of which were 4 strains(16.7%).Univariate analysis showed that the risk factors for pulmonary infection after IE included age,hypertension,cerebrovascular disease,acute left heart failure,vegetation size,procalcitonin,brain natriuretic peptide,prolonged cardiopulmonary bypass,postoperative use of intra-aortic balloon pump(IABP),endotracheal re-intubation,postoperative continuous renal replacement therapy(CRRT)and prolonged mechanical ventilation support time.Logistic regression multivariate analysis showed that hypertension(OR=7.246),size of vegetations(OR=1.134),endotracheal re-intubation(OR=257.985),postoperative CRRT(OR=125.877)were the risk factors for postoperative pulmonary infection.The model had a sensitivity of 86.96%,a specificity of 96.04%,and an accuracy of 93.8%in predicting postoperative pulmonary infection.Conclusions The incidence of pulmonary infection after

关 键 词：感染性心内膜炎 肺部感染 心脏外科 危险因素 

分 类 号：R542.41[医药卫生—心血管疾病]