摘要
目的 探讨急性Stanford A型主动脉夹层(AAAD)术后患者发生呼吸机相关肺炎(VAP)的危险因素,分析感染病原菌分布。方法 选取南京医科大学第一附属医院2015年4月-2020年10月行A型夹层标准术且术后使用机械通气的139例患者,根据是否出现VAP分为感染组(n=35)和非感染组(n=104),对年龄、性别、住院天数、呼吸机支持天数、使用呼吸机次数、是否行急诊手术等多项临床病例资料进行病例对照分析,探索危险因素,分析病原菌分布特点。结果 单因素分析显示高龄、长时间机械通气、频繁气管插管可能会增加术后VAP感染概率;多因素分析显示机械通气时间延长(OR=1.197,95%CI:1.102~1.299)是A型夹层标准术后发生VAP的独立危险因素。机械通气时间越长,感染风险越高,尤其是>10 d的患者,VAP发生率>70%。术后发生VAP的病原菌主要为鲍氏不动杆菌、肺炎克雷伯菌、嗜麦芽寡养单胞菌,耐药菌主要为泛耐药鲍氏不动杆菌(MDR-AB)、耐碳青霉烯铜绿假单胞菌(CR-PA)和肺炎克雷伯菌(CR-KP)。结论 临床需积极采取预防措施,降低VAP感染风险,防治多药耐药菌感染,尤其尽可能缩短机械通气时间,改善预后。
OBJECTIVE To explore the risk factors for postoperative ventilator-associated pneumonia(VAP) in patients with acute Stanford A aortic dissection and analyze the distribution of pathogens. METHODS From Apr 2015 to Oct 2020, a total of 139 patients who underwent type A dissection standard surgery and were treated with mechanical ventilation after the surgery were enrolled in the study and were divided into the infection group with 35 cases and the non-infection group with 104 cases according to the status of VAP. The case-controlled study was carried out for the clinical data of the patients, including age, gender, length of hospital stay, duration of mechanical ventilation, number of times of ventilation and emergency surgery. The risk factors were explored, and the distribution of pathogens was observed. RESULTS Univariate analysis showed that the advanced age, long time of mechanical ventilation and frequent endotracheal intubation may increase the probability of VAP after surgery. Multivariate analysis indicated that the long time of mechanical ventilation(OR=1.197,95%CI:1.102~1.299) was the independent risk factor for the VAP after type A dissection standard surgery. The longer the mechanical ventilation duration, the higher the risk of infection was;the incidence of VAP was more than 70% among the patients with the mechanical ventilation duration more than 10 days. Acinetobacter baumannii, Klebsiella pneumoniae and Stenotrophomonas maltophilia were dominant among the pathogens causing the postoperative VAP. Pandrug-resistant A.baumannii, carbapenem-resistant Pseudomonas aeruginosa(CRPA) and carbapenem-resistant K. pneumoniae(CRKP) were the major species of drug-resistant bacteria. CONCLUSION It is necessary for the hospital to actively take prevention measures to reduce the risk of VAP, prevent the multidrug-resistant organisms infections and shorten the mechanical ventilation duration as much as possible so as to improve the prognosis.
作者
臧凤
金霞
夏晓洁
葛子君
朱庆堂
杨剑税
ZANG Feng;JIN Xia;XIA Xiao-jie;GE Zi-jun;ZHU Qing tang;YANG Jian-shui(The First Affiliated Hospital with Nanjing Medical University,Nanjing,Jiangsu 210029,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2022年第2期207-211,共5页
Chinese Journal of Nosocomiology
基金
国家重点研发计划基金资助项目(2018YFC1314900、2018YFC1314901)
中国老年医学学会感染防控研究基金资助项目(GRYJ-XL2018009、GRYJ-XL2018016)
江苏省医院管理创新研究基金资助项目(JSYGY-3-2019-484)
江苏省科技厅重点研发计划基金资助项目(BE2016002-4)。
