目的 分析成人體外循環(huán)心臟術(shù)后影響呼吸機(jī)相關(guān)性肺炎( VAP) 發(fā)生的危險(xiǎn)因素。方法 對(duì)廈門大學(xué)附屬中山醫(yī)院心臟外科重癥監(jiān)護(hù)病房( CSICU) 2002 年1 月～2008 年6 月間收治連續(xù)體外循環(huán)心臟手術(shù)后機(jī)械通氣超過48 h 的127 例成年患者進(jìn)行回顧性分析, 根據(jù)發(fā)生VAP與否將其分為VAP組及對(duì)照組。對(duì)患者的臨床資料先進(jìn)行單因素分析篩選, 并將有意義的變量進(jìn)行多因素回歸分析。結(jié)果 體外循環(huán)心臟術(shù)后VAP總發(fā)病率5. 1% , 發(fā)生VAP患者死亡率為28. 1% 。單因素分析顯示: VAP 組體外循環(huán)時(shí)間、機(jī)械通氣時(shí)間、圍手術(shù)期血液制品用量、術(shù)后CSICU 入住天數(shù)( P lt; 0. 001) 、術(shù)后低心排綜合征的發(fā)生率、氣管切開率( P lt; 0. 01) , 大動(dòng)脈手術(shù)率、術(shù)后死亡率( P lt;0. 05) 均高于對(duì)照組; 術(shù)前左室射血分?jǐn)?shù)( LVEF) 、術(shù)后氧合指數(shù)( PaO2 /FiO2 ) 低于對(duì)照組( P lt;0. 001) 。Logistic 多因素回歸分析顯示: 體外循環(huán) gt;120 min( OR= 6. 352, P = 0. 000) 、術(shù)后PaO2 /FiO2低于300 mmHg( OR= 3. 642, P = 0. 017) 、血液制品用量≥1500 mL( OR = 5. 083, P = 0. 039) 、機(jī)械通氣時(shí)間≥5 d( OR = 9. 074, P = 0. 047) 、氣管切開( OR= 19. 899, P = 0. 021) 與VAP 的發(fā)生明顯相關(guān)。 64 例VAP患者中共培養(yǎng)出病原菌102 株, 其中革蘭陰性菌62 株( 60. 8% ) , 革蘭陽性菌19 株( 18. 6% ) ; 真菌21 株( 20. 6% ) 。結(jié)論 心臟手術(shù)體外循環(huán)時(shí)間長(zhǎng)、術(shù)后低氧血癥、大量血液制品應(yīng)用, 長(zhǎng)時(shí)間機(jī)械通氣和氣管切開是體外循環(huán)心臟術(shù)后VAP發(fā)生的危險(xiǎn)因素
引用本文： 尤顥,廖崇先,楊謙,單忠貴,趙霞,邱風(fēng),林智,郭宏偉,朱鵬. 成人體外循環(huán)心臟術(shù)后呼吸機(jī)相關(guān)肺炎的危險(xiǎn)因素分析. 中國(guó)呼吸與危重監(jiān)護(hù)雜志, 2009, 09(2): 162-165. doi: 復(fù)制
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| 2. | Wiener-Kronish JP, Dorr HI. Ventilator-associated pneumonia:Problems with diagnosis and therapy. Best Pract Res Clin Anaesthesiol, 2008, 22: 437-449. |
| 3. | 中華醫(yī)學(xué)會(huì)呼吸病學(xué)分會(huì). 醫(yī)院獲得性肺炎診斷和治療指南( 草案) . 中華結(jié)核和呼吸雜志, 1999, 22: 201-208. |
| 4. | 許建屏, 史藝, 葛翼鵬, 等. 瓣膜手術(shù)后呼吸功能衰竭的危險(xiǎn)因素分析. 中華胸心血管外科雜志, 2006, 22: 217-219. |
| 5. | Rajakaruna C, Rogers CA, Angelini GD, et al. Risk factors for and economic implications of prolonged ventilation after cardiac surgery.J Thorac Cardiovasc Surg, 2005, 130: 1270-1277. |
| 6. | Sim ek S, Yurtseven N, Ger ekogalu H, et al. Ventilator-associated pneumonia in a cardiothoracic surgery centre, postoperative intensive care unit. J Hosp Infect, 2001, 47: 321-324. |
| 7. | Bouza E, Hortal J, Munoz P, et al. Postoperative infections after major heart surgery and prevention of ventilator-associated pneumonia: a one-day European prevalence study( ESGNI-008 ) . J Hosp Infect, 2006 , 64: 224 -230. |
| 8. | Day JR, Taylor KM. The systemic inflammatory response syndrome and cardiopulmonary bypass. Int J Surg, 2005, 3: 129-140. |
| 9. | Nakasuji M, Matsushita M, Asada A. Risk factors for prolonged ICU stay in patients following coronary artery bypass grafting with a long duration of cardiopulmonary bypass. J Anesth, 2005, 19: 118-123. |
| 10. | Banbury MK, Brizzio ME, Rajeswaran J, et al. Transfusion increases the risk of postoperative infection after cardiovascular surgery. J Am Coll Surg, 2006, 202: 131-138. |
| 11. | Buza E, P rez A, Mu oz P, et al. Ventilator-associated pneumonia after heart surgery: a prospective analysis and the value of surveillance. Crit Care Med, 2003, 31, 1964-1970. |
| 12. | E Solh AA, Bhora M, Pineda L, et al. Nosocomial pneumonia in elderly patients following cardiac surgery. Respir Med, 2006, 100 :729-736. |
- 1. Rello J, Paiva JA, Baraibar J, et al. International conference for thedevelopment of consensus on the diagnosis and treatment of ventilator-associated pneumonia. Chest, 2001, 120: 955-970.
- 2. Wiener-Kronish JP, Dorr HI. Ventilator-associated pneumonia:Problems with diagnosis and therapy. Best Pract Res Clin Anaesthesiol, 2008, 22: 437-449.
- 3. 中華醫(yī)學(xué)會(huì)呼吸病學(xué)分會(huì). 醫(yī)院獲得性肺炎診斷和治療指南( 草案) . 中華結(jié)核和呼吸雜志, 1999, 22: 201-208.
- 4. 許建屏, 史藝, 葛翼鵬, 等. 瓣膜手術(shù)后呼吸功能衰竭的危險(xiǎn)因素分析. 中華胸心血管外科雜志, 2006, 22: 217-219.
- 5. Rajakaruna C, Rogers CA, Angelini GD, et al. Risk factors for and economic implications of prolonged ventilation after cardiac surgery.J Thorac Cardiovasc Surg, 2005, 130: 1270-1277.
- 6. Sim ek S, Yurtseven N, Ger ekogalu H, et al. Ventilator-associated pneumonia in a cardiothoracic surgery centre, postoperative intensive care unit. J Hosp Infect, 2001, 47: 321-324.
- 7. Bouza E, Hortal J, Munoz P, et al. Postoperative infections after major heart surgery and prevention of ventilator-associated pneumonia: a one-day European prevalence study( ESGNI-008 ) . J Hosp Infect, 2006 , 64: 224 -230.
- 8. Day JR, Taylor KM. The systemic inflammatory response syndrome and cardiopulmonary bypass. Int J Surg, 2005, 3: 129-140.
- 9. Nakasuji M, Matsushita M, Asada A. Risk factors for prolonged ICU stay in patients following coronary artery bypass grafting with a long duration of cardiopulmonary bypass. J Anesth, 2005, 19: 118-123.
- 10. Banbury MK, Brizzio ME, Rajeswaran J, et al. Transfusion increases the risk of postoperative infection after cardiovascular surgery. J Am Coll Surg, 2006, 202: 131-138.
- 11. Buza E, P rez A, Mu oz P, et al. Ventilator-associated pneumonia after heart surgery: a prospective analysis and the value of surveillance. Crit Care Med, 2003, 31, 1964-1970.
- 12. E Solh AA, Bhora M, Pineda L, et al. Nosocomial pneumonia in elderly patients following cardiac surgery. Respir Med, 2006, 100 :729-736.