摘要
目的 分析冠状动脉旁路移植术（CABG）术后患者呼吸机相关性肺炎（VAP）发生的危险因素,并对其病原学进行分析.方法 回顾性分析2014年6月至2016年6月在泰达国际心血管病医院行CABG术后患者1414例的相关临床资料,并根据术后是否发生VAP分为VAP组（n=42）和非VAP组（n=1372）.采用多因素Logistic回归分析CABG术后患者发生VAP的危险因素,并对感染患者的病原菌分布和药敏试验进行分析.结果 1414例CABG术后患者中,术后发生VAP 42例,发生率为2.97％.多因素Logistic回归分析发现有吸烟史（OR=2.216,95％CI 1.018～4.825,P〈0.05）、呼吸机应用时间〉48 h（OR=7.457,95％CI 3.443～16.161,P〈0.01）、左室射血分数（LVEF）〈40％（OR=3.524,95％CI 1.203～10.325,P〈0.05）和术后发生急性肾损伤（OR=16.239,95％CI 7.551～34.924,P〈0.01）是CABG术后患者发生VAP的独立危险因素.42例VAP患者共检出病原菌42株,其中革兰阴性菌37株,革兰阳性菌2株,真菌3株.革兰阴性菌主要为肺炎克雷伯菌肺炎亚种（23株,54.76％）和洋葱伯克霍尔德菌（6株14.27％）.革兰阳性菌为金黄色葡萄球菌（2株,4.76％）.真菌为白假丝酵母菌（3株,7.14％）.肺炎克雷伯菌肺炎亚种对多种药物敏感,对阿米卡星、氨曲南、美罗培南、左氧氟沙星耐药性均〈10％,对头孢他啶、哌拉西林耐药性均〈25％.洋葱伯克霍尔德菌对阿米卡星、氨苄西林、氨曲南、头孢唑啉、庆大霉素及磺胺甲噁唑天然耐药.结论 CABG术后患者VAP发生率较高,病原菌以革兰阴性菌为主.临床上应积极采取必要措施加以预防及治疗,以期改善预后.
Objective To analyze the risk factors and pathogen distribution of ventilator-associated pneumonia （VAP） in patients following coronary artery bypass grafting （CABG）.Methods The clinical data of 1414 patients undergoing CABG in Teda International Cardiovascular Hospital from June 2014 to June 2016 were retrospectively analyzed .The VAP developed following CABG in 42 patients （ VAP group ） and not occurred in 1372 patients （ non-VAP group） .Multivariate logistic regression was used to analyze the risk factors of VAP in patients after CABG , and the microbial culture and drug sensitivity test were performed in VAP patients.Results The incidence rate of VAP after CABG was 2.97％ （42/1414）.Multivariate logistic regression analysis showed that history of smoking （ OR =2.216, 95％ CI 1.018 -4.825, P 〈0.05）, mechanical ventilation time 〉48 h （OR=7.457, 95％ CI 3.443-16.161, P〈0.01）, LVEF〈40％（OR=3.524 , 95％ CI 1.203-10.325, P〈0.05） and postoperative acute kidney injury （OR=16.239, 95％ CI 7.551 -34.924, P 〈0.01） were independent risk factors for VAP in patients after CABG.A total of 42 pathogen strains were detected in 42 patients with VAP, including 37 strains of Gram-negative bacteria, 2 strains of Gram-positive bacteria, and 3 strains of fungus.Gram-negative bacteria mainly were Klebsiella pneumoniae subspecies （ n =23, 54.76％） and Burkholderia cepacia （ n =6, 14.27％）;the Gram-positive bacteria were Staphylococcus aureus （ n =2, 4.76％）;the fungus was Candida albicans （ n =3, 7.14％）.Klebsiella pneumoniae was sensitive to many antibiotics;and the resistance rate to amikacin , aztreonam , meropenem , and levofloxacin was 〈10％, the resistance rate to ceftazidime and piperacillin was 〈25％. Burkholderia cepacia was naturally resistant to amikacin , ampicillin, aztreonam, cefazolin, gentamicin and sulfamethoxazole .Conclusion The incidence of VAP was higher in patients after CABG , and the involved pathogens were mainly Gram-negative bact
作者
樊国亮
陈铁男
刘志刚
王正清
谢继庆
李秀勇
张波
戴娟
Fan Guoliang;Chen Tienan;Liu Zhigang;Wang Zhengqing;Xie Jiqing;Li Xiuyong;Zhang Bo;Dai Juan(Intensive Care Unit;Department of Cardiac Surgery;Department of Nosocomial Infection Management,Teda International Cardiovascular Hospital,Tianfin 300457,China)
出处
《中华临床感染病杂志》
2018年第5期359-364,共6页
Chinese Journal of Clinical Infectious Diseases
基金
滨海新区重点支持项目（2013BWKZ006）
关键词
肺炎
呼吸机相关性肺炎
冠状动脉旁路移植术
危险因素
病原菌分布
Pneumonia
Ventilator associated pneumonia
Coronary artery bypass grafting
Risk factors
Pathogen distribution
