摘要
目的:分析冠状动脉旁路移植术(CABG)后肺部感染发生的危险因素。方法:回顾性分析1 414例择期行CABG患者的临床资料,根据典型的临床表现、胸片检查以及呼吸道分泌物培养阳性结果,确诊术后肺部细菌性感染。对患者肺部感染可能相关因素进行多因素Logistic回归分析。结果:42例(2.97%)患者确诊为术后肺部感染。相较于无肺部感染组,肺部感染患者年龄较大,吸烟、心脑血管病史比例高,左心室舒张末直径较大,左心室射血分数(LVEF)<40%比例高,术中应用体外循环比例高,悬浮红细胞输注量较大,体外循环时间和主动脉阻断时间较长,术后发生急性肾损伤(AKI)、二次气管插管、二次开胸探查的比例高,且呼吸机应用时间和重症监护病房(ICU)住院时间长(P均<0.05)。多因素Logistic回归分析显示,AKI(OR=16.239,95%CI:7.551～34.924)、呼吸机应用时间>48 h(OR=7.457,95%CI:3.44～16.161)、术前长期吸烟(OR=2.20,95%CI:1.018～4.825)、LVEF<40%(OR=3.524,95%CI:1.203～10.325)为CABG术后发生肺部感染的独立危险因素。结论:CABG后肺部感染与围手术期多种因素有关,其中术后AKI发生、呼吸机应用时间>48 h、术前长期吸烟及LVEF低下是CABG后肺部感染发生的独立危险因素,临床上应积极采取必要措施加以预防,以期进一步改善预后。
Objectives: To analyze the risk factors of pulmonary infection in patients after coronary artery bypass grafting(CABG).Methods: The clinical data of 1 414 patients undergoing coronary artery bypass grafting were analyzed retrospectively. The diagnosis of pulmonary bacterial infection was made according to the typical clinical manifestations, chest X-ray examination, and positive respiratory tract analysis. Univariate and multivariate regression analysis were performed on possible factors related to perioperative period.Results: There were 42 cases( 2.97%)postoperative pulmonary infection. The risk factors of postoperative pulmonary infection included: older, preoperative long-term smoking, left ventricular ejection fraction <40%, postoperative acute renal function injury, cardiopulmonary bypass application, ventilator time, etc. The multiple factor Logistic regression analysis showed that AKI(OR=16.239, 95%CI: 7.551-34.924), ventilator application >48 h(OR=7.457, 95%CI: 3.44-16.161), preoperative long-term smoking(OR=2.20, 95% CI:1.018-4.825), and left ventricular ejection fraction <40%(OR=3.524, 95% CI: 1.203-10.325) were independent predictors of pulmonary infection after CABG. Conclusions: The pulmonary infection after coronary artery bypass grafting is related to various factors in the perioperative period. The preoperative long-term smoking, ventilator application >48 h, postoperative AKI and low left ventricular ejection fraction are independent risk factors for pulmonary infection after CABG, and the necessary measures should be taken to prevent the pulmonary infection toimprove the prognosis of these patients.
作者
樊国亮
张英飞
陈铁男
刘志刚
王正清
谢继庆
李志昊
张波
张宁
FAN Guoliang;ZHANG Yingfei;CHEN Tienan;LIU Zhigang;WANG Zhengqing;XIE Jiqing;LI Zhihao;ZHANG Bo;ZHANG Ning(Intensive Care Unit,Teda International Cardiovascular Hospital,Tianjin(300457),China)
出处
《中国循环杂志》
CSCD
北大核心
2019年第2期139-143,共5页
Chinese Circulation Journal
关键词
体外循环
冠状动脉旁路移植术
肺内感染
急性肾损伤
危险因素
cardiopulmonary bypass
coronary artery bypass grafting
pulmonary infection
acute renal injury
risk factors
