摘要
目的：探讨＞70岁老年患者心脏手术后呼吸机相关性肺炎（VAP）的发病风险及相关病原学特点，以指导临床合理使用抗菌药物。方法回顾性地分析2013年1月至2014年6月南京医科大学附属南京医院心脏外科重症监护病房（ICU）收治的机械通气时间＞48h且年龄＞70岁的老年患者33例，根据是否发生VAP分为VAP组及非VAP组，对两组患者的临床资料进行分析，筛选术后VAP的危险因素、致病菌及相应敏感药物。结果33例患者中共16例患者发生VAP。单因素分析显示，两组之间急性生理与慢性健康评分Ⅱ（APACHE Ⅱ）、主动脉阻断时间、体外循环时间、机械通气时间及ICU住院时间差异有统计学意义（P＜0.01）。多因素回归分析显示，主动脉阻断时间及机械通气时间与VAP发生明显相关。分离病原菌19株，多以革兰阴性杆菌为主（84.2%），其中肺炎克雷伯菌及铜绿假单胞菌是主要致病菌，革兰阳性球菌及真菌发生率较低，万古霉素对革兰阳性球菌抗菌活性为100%。结论老年患者心脏术后VAP的发生与多种因素有关，需提高手术技术缩短主动脉阻断时间，尽早拔管，合理使用抗菌药物，以改善老年患者心脏术后VAP预后。
Objective To explore the risk factors for ventilator-associated pneumonia （VAP） in the patients over 70 years old after heart surgery and investigate the characteristics of the related etiology so as to guide clinical rational use of antimicrobial agents. Methods Clinical data of 33 elderly patients （over 70 years old） with the duration of mechanical ventilation more than 48h after cardiac surgery in our ICU from January 2013 to June 2014 were collected and retrospectively analyzed. The cohort was assigned into VAP and non-AVP groups, and their clinical data were compared and analyzed to screen the risk factors of postoperative VAP, pathogenic bacteria and their sensitive drugs. Results In the 33 patients, there were 16 patients having VAP. Univariate analysis showed that significant differences were seen in the scores of Acute Physiology and Chronic Health Evaluation Ⅱ （APACHE Ⅱ）, aorta blocking time, extracorporeal circulation time, mechanical ventilation time and length of ICU hospitalization between the VAP and non-VAP groups （P〈0.01）. Multivariate analysis indicated that aorta blocking time and duration of mechanical ventilation were significantly associated with VAP. Among the 19 isolated strains of pathogenic bacteria, most of them were Gram-negative bacilli （84.2%）. Klebsiella pneumoniae and Pseudomonas aeruginosa were the most common ones. The incidences of Gram-positive cocci and fungi were quite low. The antibacterial activity of vancomycin was 100% to Gram-positive cocci. Conclusion A variety of risk factors are related to postoperative VAP in the elderly patients after cardiac surgery. We clinicians should improve surgical skills to shorten the duration of mechanical ventilation and aortic cross-clamping time and use antimicrobial agents rationally so as to improve the prognosis of VAP in the elderly after cardiac surgery.
出处
《中华老年多器官疾病杂志》
2015年第4期263-267,共5页
Chinese Journal of Multiple Organ Diseases in the Elderly
关键词
心脏术后
呼吸机相关性肺炎
临床分析
致病菌
post-cardiac surgery
ventilator-associated pneumonia
clinical analysis
pathogenic bacteria
