心脏外科手术后肺炎的危险因素分析  

Risk factors for postoperative pneumonia following cardiac surgical procedures

作　　者：王阔 范志伟 王东进 Wang Kuo;Fan Zhiwei;Wang Dongjin(Department of Cardio-Thoracic Surgery,Nanjing Drum Tower Hospital Clinical College of Xuzhou Medical University,Nanjing 210008,China;Department of Cardio-Thoracic Surgery,Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine,Nanjing 210008,China;Department of Cardio-Thoracic Surgery,Nanjing Drum Tower Hospital Affiliated Hospital of Medical School,Nanjing University,Nanjing 210008,China)

机构地区：[1]徐州医科大学南京鼓楼临床学院心脏大血管外科,南京210008 [2]南京中医药大学南京鼓楼临床学院心脏大血管外科,南京210008 [3]南京大学医学院附属鼓楼医院心脏大血管外科,南京210008

出　　处：《中华解剖与临床杂志》2024年第9期597-602,共6页Chinese Journal of Anatomy and Clinics

摘　　要：目的探讨心脏外科手术患者术后肺炎(POP)的危险因素。方法回顾性队列研究。纳入2020年11月—2021年10月南京鼓楼医院心胸外科行心脏手术的1107例患者的临床资料,其中男711、女396,年龄32~77[59(51,68)]岁。根据患者是否发生POP分为2组:POP组105,非POP组1002例。观察指标:(1)分析心脏手术后患者POP的发病情况,比较2组患者的病死率。(2)纳入年龄、性别、体质量指数、术前营养不良、吸烟史、脑卒中史、合并高血压、合并糖尿病、序贯器官衰竭评分(SOFA)≥1分、射血分数、纽约心脏病协会(NYHA)分级Ⅲ/Ⅳ级、是否微创手术、手术类型(包括瓣膜手术、冠状动脉旁路移植术、主动脉手术及瓣膜手术联合冠状动脉旁路移植术)、体外循环时间、术中输血、术后机械通气时间、术后有无急性肾衰竭、重症监护室住院时间等因素,应用logistic回归分析筛选心脏外科手术患者POP的独立危险因素。结果(1)心脏手术后患者POP的发生率为9.5%(105/1107);POP组患者的病死率为15.2%(16/105),高于非POP组患者的病死率(1.1%,11/1002),差异有统计学意义(χ^(2)=70.41,P<0.001)。(2)单因素分析显示,2组患者年龄、术前营养不良、合并糖尿病、脑卒中史、SOFA≥1分、NYHAⅢ级或Ⅳ级、手术类型、体外循环时间、术中输血、术后急性肾衰竭、机械通气时间比较,差异均有统计学意义(P值均<0.05)。进一步多因素logistic回归分析结果显示,年龄>55岁(OR=4.107,95%CI:2.084~8.096,P<0.001)、术前营养不良(OR=4.681,95%CI:2.451~8.940,P<0.001)、合并糖尿病(OR=1.962,95%CI:1.048~3.673,P=0.035)、主动脉手术(OR=11.342,95%CI:5.064~25.401,P<0.001)、体外循环时间>135 min(OR=2.977,95%CI:1.726~5.136,P<0.001)和机械通气时间>20 h(OR=4.369,95%CI:2.610~7.312,P<0.001)是心脏外科手术后发生POP的独立危险因素。结论心脏外科手术患者POP的发生率较高,且病死率高达15.2%;其发生与多种危险因Objective This study aimed to investigate the risk factors of postoperative pneumonia(POP)following cardiac surgical procedures.Methods A retrospective cohort study was conducted.The clinical data of 1107 patients who underwent cardiac surgery in the Department of Cardiothoracic Surgery of Nanjing Drum Tower Hospital from November 2020 to October 2021 were included,including 711 males and 396 females,aged 32-77(59[51,68])years.The patients were divided into two groups whether or not they had POP after surgery:105 cases in the POP group and 1002 cases in the non-POP group.The observation indicators were as follows:The incidence of POP in patients after cardiac surgery was examined,and the fatality rates of the two groups were compared.Age,gender,BMI,preoperative malnutrition,smoking,hypertension,diabetes,stroke,sequential organ failure assessment(SOFA)≥1 point,ejection fraction,New York Heart Association(NYHA)gradesⅢ/Ⅳ,minimally invasive surgery,type of surgery(including aortic surgery,valve surgery,coronary artery bypass grafting,and valve surgery in conjunction with coronary artery bypass grafting),cardiopulmonary bypass time,intraoperative blood transfusion,postoperative mechanical ventilation time,postoperative acute renal failure,and ICU stay were included.Logistic regression analysis was also used to screen the independent risk factors of POP after cardiac surgery.Results The incidence rate of POP after cardiac surgery was 9.5%(105/1107),and the fatality rate of patients with POP was 15.2%(16/105),which was significantly higher than those without POP(1.1%,11/1002).This difference was statistically significant(χ^(2)=70.41,P<0.001).Univariate analysis showed significant differences in age,preoperative malnutrition,diabetes,stroke,SOFA≥1 point,NYHA gradesⅢ/Ⅳ,surgery type,cardiopulmonary bypass time,intraoperative blood transfusion,postoperative acute renal failure,and duration of mechanical ventilation between the two groups(all P values<0.05).Further multivariate logistic regression analysis showe

关 键 词：心脏外科手术 术后肺炎 危险因素 

分 类 号：R654.2[医药卫生—外科学] R563.1[医药卫生—临床医学]