摘要
目的探讨心脏大血管术后患者肺部感染的病原学及危险因素。方法选取2017年10月-2020年3月海南医学院第一附属医院收治的心脏大血管手术患者247例的资料进行回顾性分析。分析患者的手术类型及相应的肺部感染情况。统计并分析肺部感染患者的病原学及药敏试验结果。筛选心脏大血管术后患者肺部感染的影响因素。结果 247例患者术后共有32例发生肺部感染,感染率为12.96%。不同手术分类的感染率比较差异具有统计学意义(χ^(2)=22.834,P<0.001),其中主动脉置换手术后发生肺部感染的比例最高。肺部感染患者痰液标本中共分离出58株病原体,革兰阴性菌34株,占58.62%,革兰阳性菌19株,占32.76%,真菌5株,占8.62%。最常见的病原体为洋葱伯克霍尔德菌,共12株,占20.69%。Logistic多因素回归分析显示,年龄较大、手术类型为主动脉置换、手术耗时较长、住院时间较长、呼吸机使用时间较长,均为心脏大血管术后患者肺部感染的影响因素(P<0.05)。结论心脏大血管手术后患者出现肺部感染的风险较高,感染的病原体以革兰阴性菌为主。心脏大血管手术后患者出现肺部感染的影响因素较多,应在工作中采取针对性的预防措施。
OBJECTIVE To explore the risk factors, etiology and drug resistance of pulmonary infection in patients after cardiac surgery. METHODS The data of 247 patients who were admitted to the First Affiliated Hospital of Hainan Medical College from Oct. 2017 to Mar. 2020 undergoing cardio-macrovascular surgery were collected for retrospective analysis. The types of surgery and corresponding lung infections for all patients were recorded. The results of etiology and drug sensitivity test of patients with pulmonary infection were statistically analyzed. The risk factors of pulmonary infection in patients after cardiac major vessel operation were analyzed. RESULTS Of all 247 patients, pulmonary infection occurred in 32 cases, with the infection rate of 12.96%. The infection rate of different surgical categories was significant(χ^(2)=22.834, P<0.001), and the highest rate of pulmonary infection occurred after aortic replacement surgery. A total of 58 pathogens were isolated from the sputum specimens of patients with lung infection, including 34 strains of Gram-negative bacteria(58.62%), 19 strains of Gram-positive bacteria(32.76%) and 5 strains of fungi(8.62%). Burkholderia cepacia was the most common pathogen, with 12 strains, accounting for 20.69%. Older age, type of operation for aortic replacement, longer operation time, longer hospital stay, and longer ventilator use time are all influencing factors for lung infection in patients after major cardiac and vascular surgery(P<0.05). CONCLUSION After major cardiac and vascular surgery, patients prone to have a higher risk of lung infection, and the pathogens of the infection are mainly Gram-negative bacteria. There are many factors influencing the occurrence of lung infections in patients after major cardiac and vascular surgery, so targeted preventive measures should be taken in the work.
作者
赵映
刘苏
刘淑芳
闫庆峰
王书君
ZHAO Ying;LIU Su;LIU Shu-fang;YAN Qing-feng;WANG Shu-jun(The First Affiliated Hospital of Hainan Medical College,Haikou,Hainan 570000,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2021年第7期1039-1042,共4页
Chinese Journal of Nosocomiology
基金
国家自然科学基金资助项目(81360029)。
关键词
心脏
大血管
肺部感染
创伤
机械通气
Heart
Major blood vessel
Lung infection
Trauma
Mechanical ventilation
