2014—2023年手术后肺炎临床分布特点及变化趋势  

Clinical distribution characteristics and changing trend of postoperative pneumonia,2014-2023

作　　者：郭艳[1] 李占结 GUO Yan;LI Zhanjie(Department of Infection Management,The First People’s Hospital of Zhengzhou,Zhengzhou 450002,China;Department of Infection Management,The First Affiliated Hospital with Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]郑州市第一人民医院感染管理科,河南郑州450002 [2]南京医科大学第一附属医院感染管理处,江苏南京210029

出　　处：《中国感染控制杂志》2025年第4期506-511,共6页Chinese Journal of Infection Control

基　　金：江苏省科协青年科技人才托举工程(卫生健康领域)(JSTJ-2023-WJ006);江苏科技智库计划(青年)项目(JSKX24055);江苏省医院协会医院管理创新研究课题(JSYGY-3-2023-559);中华预防医学会医院感染学科发展青年人才托举项目(CPMA-HAIC-2004012900108);江苏省人民医院第三期优秀中青年人才培养项目(YNRCQN0314);南京医科大学第一附属医院青年基金培育计划(PY2022017)。

摘　　要：目的分析手术后肺炎临床分布特点及变化趋势,为手术后肺炎的进一步监测和管理提供依据。方法收集南京医科大学第一附属医院2014—2023年手术后肺炎患者的临床资料,回顾性分析手术后肺炎发病率、呼吸机相关肺炎(VAP)占比变化趋势及手术后肺炎发生时间和病原体分布,以及各科室手术后肺炎发病率。结果2014—2023年全院共有653609例患者接受外科手术,手术例次数为676245次,其中有2934例次发生手术后肺炎,手术后肺炎发病率为0.43%。手术后肺炎患者平均年龄为(59.76±16.53)岁,男性占比68.58%;手术后肺炎发病率由2014年的2.00%降至2023年的0.10%,VAP占比由2014年的9.92%上升至2023年的99.10%,差异均有统计学意义(均P<0.001)。手术后肺炎发生在术后7、10、30 d内的分别占65.81%、78.80%、95.64%,发生率居前三的科室分别为心脏大血管外科(5.277%)、神经外科(2.114%)和胸外科(1.130%);感染病原体以革兰阴性菌为主(77.58%)。结论手术后肺炎发病率呈下降趋势,其中VAP患者应作为后续改进工作的重点关注对象,心脏血管外科、神经外科和胸外科则是手术后肺炎的重点关注科室,手术后10 d内应作为手术后肺炎的重点关注时间段。Objective To analyze the clinical distribution characteristics and changing trend of postoperative pneumonia(POP),and provide basis for further monitoring and management of POP.Methods Clinical data of POP patients in the First Affiliated Hospital with Nanjing Medical University from 2014-2023 were collected.The incidence of POP,the changing trend of proportion of ventilator-associated pneumonia(VAP),the occurrence time,pathogen distribution,and incidence of POP in various departments were analyzed retrospectively.Results From 2014 to 2023,a total of 653609 patients in the hospital received surgery,with 676245 times of operations,out of which 2934 cases had POP,and the incidence of POP was 0.43%.The average age of POP patients was(59.76±16.53)years old,with 68.58%being male.The incidence of POP decreased from 2.00%in 2014 to 0.10%in 2023,and the proportion of VAP increased from 9.92%in 2014 to 99.10%in 2023,with statistically significant differences(all P<0.001).POP occurred within 7,10,and 30 days after surgery accounted for 65.81%,78.80%,and 95.64%,respectively.The top three departments with the highest incidences were cardiovascular surgery(5.277%),neurosurgery(2.114%),and thoracic surgery(1.130%).The main pathogen of infection was Gram-negative bacteria(77.58%).Conclusion The incidence of POP shows a downward trend.VAP patients should be the focus of follow-up improvement work.Departments of cardiovascular surgery,neurosurgery,and thoracic surgery are the key departments of POP,and 10 days after surgery should be the critical period of POP.

关 键 词：肺炎 手术后肺炎 临床分布 变化趋势 呼吸机相关肺炎 

分 类 号：R181.32[医药卫生—流行病学]