成人體外循環心臟術后呼吸機相關肺炎的危險因素分析_《中國呼吸與危重監護雜志》

作者：

 尤顥 , 廖崇先 , 楊謙 , 單忠貴 , 趙霞 , 邱風 , 林智 , 郭宏偉 , 朱鵬

廈門大學附屬中山醫院心臟外科（福建廈門 361004）;

關鍵詞：

呼吸機相關性肺炎心臟手術體外循環危險因素多因素回歸分析

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目的分析成人體外循環心臟術后影響呼吸機相關性肺炎( VAP) 發生的危險因素。方法對廈門大學附屬中山醫院心臟外科重癥監護病房( CSICU) 2002 年1 月～2008 年6 月間收治連續體外循環心臟手術后機械通氣超過48 h 的127 例成年患者進行回顧性分析, 根據發生VAP與否將其分為VAP組及對照組。對患者的臨床資料先進行單因素分析篩選, 并將有意義的變量進行多因素回歸分析。結果體外循環心臟術后VAP總發病率5. 1% , 發生VAP患者死亡率為28. 1% 。單因素分析顯示: VAP 組體外循環時間、機械通氣時間、圍手術期血液制品用量、術后CSICU 入住天數( P lt; 0. 001) 、術后低心排綜合征的發生率、氣管切開率( P lt; 0. 01) , 大動脈手術率、術后死亡率( P lt;0. 05) 均高于對照組; 術前左室射血分數( LVEF) 、術后氧合指數( PaO2 /FiO2 ) 低于對照組( P lt;0. 001) 。Logistic 多因素回歸分析顯示: 體外循環 gt;120 min( OR= 6. 352, P = 0. 000) 、術后PaO2 /FiO2低于300 mmHg( OR= 3. 642, P = 0. 017) 、血液制品用量≥1500 mL( OR = 5. 083, P = 0. 039) 、機械通氣時間≥5 d( OR = 9. 074, P = 0. 047) 、氣管切開( OR= 19. 899, P = 0. 021) 與VAP 的發生明顯相關。 64 例VAP患者中共培養出病原菌102 株, 其中革蘭陰性菌62 株( 60. 8% ) , 革蘭陽性菌19 株( 18. 6% ) ; 真菌21 株( 20. 6% ) 。結論心臟手術體外循環時間長、術后低氧血癥、大量血液制品應用, 長時間機械通氣和氣管切開是體外循環心臟術后VAP發生的危險因素

引用本文： 尤顥,廖崇先,楊謙,單忠貴,趙霞,邱風,林智,郭宏偉,朱鵬. 成人體外循環心臟術后呼吸機相關肺炎的危險因素分析. 中國呼吸與危重監護雜志, 2009, 09(2): 162-165. doi: 復制

1.	Rello J, Paiva JA, Baraibar J, et al. International conference for thedevelopment of consensus on the diagnosis and treatment of ventilator-associated pneumonia. Chest, 2001, 120: 955-970.
2.	Wiener-Kronish JP, Dorr HI. Ventilator-associated pneumonia:Problems with diagnosis and therapy. Best Pract Res Clin Anaesthesiol, 2008, 22: 437-449.
3.	中華醫學會呼吸病學分會. 醫院獲得性肺炎診斷和治療指南( 草案) . 中華結核和呼吸雜志, 1999, 22: 201-208.
4.	許建屏, 史藝, 葛翼鵬, 等. 瓣膜手術后呼吸功能衰竭的危險因素分析. 中華胸心血管外科雜志, 2006, 22: 217-219.
5.	Rajakaruna C, Rogers CA, Angelini GD, et al. Risk factors for and economic implications of prolonged ventilation after cardiac surgery.J Thorac Cardiovasc Surg, 2005, 130: 1270-1277.
6.	Sim　ek S, Yurtseven N, Ger　ekogalu H, et al. Ventilator-associated pneumonia in a cardiothoracic surgery centre, postoperative intensive care unit. J Hosp Infect, 2001, 47: 321-324.
7.	Bouza E, Hortal J, Munoz P, et al. Postoperative infections after major heart surgery and prevention of ventilator-associated pneumonia: a one-day European prevalence study( ESGNI-008 ) . J Hosp Infect, 2006 , 64: 224 -230.
8.	Day JR, Taylor KM. The systemic inflammatory response syndrome and cardiopulmonary bypass. Int J Surg, 2005, 3: 129-140.
9.	Nakasuji M, Matsushita M, Asada A. Risk factors for prolonged ICU stay in patients following coronary artery bypass grafting with a long duration of cardiopulmonary bypass. J Anesth, 2005, 19: 118-123.
10.	Banbury MK, Brizzio ME, Rajeswaran J, et al. Transfusion increases the risk of postoperative infection after cardiovascular surgery. J Am Coll Surg, 2006, 202: 131-138.
11.	Buza E, P　rez A, Mu　oz P, et al. Ventilator-associated pneumonia after heart surgery: a prospective analysis and the value of surveillance. Crit Care Med, 2003, 31, 1964-1970.
12.	E Solh AA, Bhora M, Pineda L, et al. Nosocomial pneumonia in elderly patients following cardiac surgery. Respir Med, 2006, 100 :729-736.

1. Rello J, Paiva JA, Baraibar J, et al. International conference for thedevelopment of consensus on the diagnosis and treatment of ventilator-associated pneumonia. Chest, 2001, 120: 955-970.
2. Wiener-Kronish JP, Dorr HI. Ventilator-associated pneumonia:Problems with diagnosis and therapy. Best Pract Res Clin Anaesthesiol, 2008, 22: 437-449.
3. 中華醫學會呼吸病學分會. 醫院獲得性肺炎診斷和治療指南( 草案) . 中華結核和呼吸雜志, 1999, 22: 201-208.
4. 許建屏, 史藝, 葛翼鵬, 等. 瓣膜手術后呼吸功能衰竭的危險因素分析. 中華胸心血管外科雜志, 2006, 22: 217-219.
5. Rajakaruna C, Rogers CA, Angelini GD, et al. Risk factors for and economic implications of prolonged ventilation after cardiac surgery.J Thorac Cardiovasc Surg, 2005, 130: 1270-1277.
6. Sim　ek S, Yurtseven N, Ger　ekogalu H, et al. Ventilator-associated pneumonia in a cardiothoracic surgery centre, postoperative intensive care unit. J Hosp Infect, 2001, 47: 321-324.
7. Bouza E, Hortal J, Munoz P, et al. Postoperative infections after major heart surgery and prevention of ventilator-associated pneumonia: a one-day European prevalence study( ESGNI-008 ) . J Hosp Infect, 2006 , 64: 224 -230.
8. Day JR, Taylor KM. The systemic inflammatory response syndrome and cardiopulmonary bypass. Int J Surg, 2005, 3: 129-140.
9. Nakasuji M, Matsushita M, Asada A. Risk factors for prolonged ICU stay in patients following coronary artery bypass grafting with a long duration of cardiopulmonary bypass. J Anesth, 2005, 19: 118-123.
10. Banbury MK, Brizzio ME, Rajeswaran J, et al. Transfusion increases the risk of postoperative infection after cardiovascular surgery. J Am Coll Surg, 2006, 202: 131-138.
11. Buza E, P　rez A, Mu　oz P, et al. Ventilator-associated pneumonia after heart surgery: a prospective analysis and the value of surveillance. Crit Care Med, 2003, 31, 1964-1970.
12. E Solh AA, Bhora M, Pineda L, et al. Nosocomial pneumonia in elderly patients following cardiac surgery. Respir Med, 2006, 100 :729-736.

《中國呼吸與危重監護雜志》

成人體外循環心臟術后呼吸機相關肺炎的危險因素分析

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《中國呼吸與危重監護雜志》

成人體外循環心臟術后呼吸機相關肺炎的危險因素分析

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