老年患者心脏手术后呼吸机相关肺炎的临床研究

Clinical study of ventilator-associated pneumonia in elderly patients after cardiac surgery

目的探讨老年患者心脏手术后发生呼吸机相关性肺炎(VAP)的危险因素以及常见病原菌,为降低老年患者心脏手术后VAP发生率提供参考依据。方法回顾分析医院150例机械通气时间≥48h、年龄>60岁的患者,按照是否发生VAP分为VAP 74例和非VAP 76例,对其临床资料进行统计分析,并对VAP患者痰液培养结果进行统计,数据采用SPSS13.0软件进行分析。结果 74例VAP患者中死亡21例,病死率达28.38%;通过分析VAP与非VAP患者的临床资料发现,大动脉手术患者、合并有低心排综合征以及行气管切开的患者术后发生VAP可能性较大,此外术前LEVF、体外循环时间、PaO2/FiO2、血液制品使用量、机械通气时间以及ICU监护时间等因素均与其发生率相关;74例发生VAP患者痰液中共培养出118株病原菌,以革兰阴性菌为主70株占60.34%,其次是真菌24株占20.69%,革兰阳性菌相对较少,仅有12株占18.97%。结论老年患者心脏直视术后VAP的发生于多种因素有关,应积极进行预防,对于已经发生的患者原则上应按照培养结果和药敏试验及时给药治疗。

OBJECTIVE To explore the risk factors for ventilator-associated pneumonia （VAP） in elderly patients after cardiac surgery and analyze the distribution of common species of pathogens so as to reduce the incidence of VAP in the elderly patients .METHODS A total of 150 patients with the duration of mechanical ventilation no less than 48 hours and more than 60 years of age were enrolled in the study and divided into the VAP group with 74 cases and the non-VAP group with 76 cases according the status of VAP ,then the clinical data were statistically analyzed ,the results of sputum culture of the VAP patients were taken for statistics ,and the statistical analysis was performed with the use of SPSS13 .0 software .RESULTS Of the 74 cases of VAP ,21 cases died with the mortality rate of 28 .38% .The analysis of the clinical data of the patients with VAP and the patients without VAP showed that the patients receiving aortic surgery ,with complication of low cardiac syndrome ,or undergoing tracheotomy were at high risk of postoperative VAP , in addition , the preoperative LEVF , extracorporeal circulation time ,PaO2/FiO2 ,use of blood products ,duration of mechanical ventilation ,and time of monitoring in ICU were associated with the incidence of VAP .Totally 118 strains of pathogens have been cultured from the sputum specimens obtained from the 74 cases of VAP ,consisting of 70 （60 .34% ） strains of gram-negative bacteria ,24 （20 .69% ） strains of fungi ,and 12 （18 .97% ） strains of gram-positive bacteria .CONCLUSIONS There are a variety of risk factors for the postoperative VAP in the elderly patients undergoing cardiac surgery .It is necessary to actively take prevention measures and reasonably use antibiotics based on the results of culture and drug susceptibility testing .