心脏瓣膜置换术患者下呼吸道微生物定植影响因素研究

Study for the influence factors of postoperative microbial colonization in lower respiratory tract for patients underwent heart valve replacement

目的调查心脏瓣膜置换术患者下呼吸道微生物定植情况,并探讨其影响因素,为临床护理干预提供依据。方法前瞻性调查2014年3-9月笔者所在医院心脏外科风湿性心脏瓣膜病行瓣膜置换术患者下呼吸道微生物定植情况,将患者分为下呼吸道微生物阳性组及阴性组,采用多元Logistic回归模型分析下呼吸道微生物定植影响因素。结果共纳入患者81例,下呼吸道微生物培养阳性者38例,定植率为46.9%,共检出定植微生物51株,其中,革兰氏阳性球菌30株(58.8%),革兰氏阴性球菌11株(21.6%),革兰氏阴性杆菌8株(15.7%),真菌2株(3.9%)。术前牙菌斑指数(PLI)≥3.0分(OR=48.924,OR95%CI 5.697,420.185;P<0.01)以及机械通气时间>18h(OR=4.192,OR95%CI 1.362,12.902;P=0.012)是心脏瓣膜置换术患者下呼吸道微生物定植的危险因素。结论术前口腔卫生状况以及机械通气时间是心脏瓣膜置换术患者下呼吸道微生物定植的影响因素,需重视患者术前口腔卫生评估,加强术前口腔护理干预;机械通气期间应尽早开始口腔护理干预,及时清除患者口咽部分泌物,以减少微生物误吸;准确掌握拔管指征,尽早拔除气管插管。

Objective To investigate the influence factors of postoperative microbial colonization in lower respiratory tract for patients underwent heart valve replacement. Method A prospective survey was conducted from March to September 2014 on postoperative microbial colonization in lower respiratory tract for patients underwent heart valve replacement in the department of cardiovascular surgery at a tertiary A level general hospital in Anhui province. Demographic and peri operative clinical data of the patients was collected and recorded. Lower respiratory tract secretion samples were collected at the time of extubating postoperatively and cultured within 2 hours. Multivariate logistic regression model was performed to analyze the influence factors of microbial colonization in lower respiratory tract. Result 81 patients were included in the prospective survey. The lower respiratory tract secretion of 38 patients （46.9%） were detected with microbial culture positive and 51 strains were cultured. Among them, 30（58.8%） gram positive coccus strains, 11（21.6%） gram negative coccus strains, 8（15.7%） gram negative bacillus strains, and 2（3.9 %） fungus strains were cultured respectively. Multivariate logistic regression analysis disclosed that preoperative PLI≥3.0 （OR=48. 924,OR 95%CI 5. 697, 420. 185;P〈0. 001） and mechanical ventilation time〉18 h （OR = 4.192, OR 95 % CI 1. 362,12. 902 ;P= 0.012） were the risk factors of microbial colonization in lower respiratory tract of the patients. Conclusion Preoperative oral hygiene status and mechanical ventilation time was the influence factor of microbial colonization in lower respiratory tract of the patients underwent heart valve replacement.