急性主动脉夹层术后鼻饲患者肺部感染分析

Analysis of pulmonary infections in patients with nasal feeding after acute aortic dissection operation

目的 分析急性主动脉夹层术后鼻饲患者肺部感染的特点及危险因素.方法 回顾性分析首都医科大学附属北京安贞医院2010年2月至2013年5月因急性主动脉夹层行急诊手术后鼻饲的72例患者的临床和细菌学资料,根据患者是否发生肺部感染分为感染组（29例）和非感染组（43例）.记录术后血乳酸水平、术后并发症发生情况以及重症监护病房（ICU）停留时间、气管插管时间、住院时间、医院死亡情况.结果 急诊主动脉夹层手术后鼻饲患者中肺部感染29例,感染率为40.3％（29/72）;感染组病死率27.6％ （8/29）,非感染组病死率9.3％ （4/43）,差异有统计学意义（P＜0.01）;感染组分离出病原菌62株,其中革兰阴性菌40株（64.5％）、革兰阳性菌14株（22.6％）、真菌8株（12.9％）;感染组ICU停留时间、气管插管时间、住院时间明显比非感染组延长[（12±7）d比（6±2）d,（8±6）d比（5±1）d,（35±10）d比（20±8）d]（P ＜0.01）,术后动脉血乳酸水平和气管切开率增高[（7.5±4.2）mmol/L比（5.4±3.6）mmol/L,48.3％（14/29）比11.6％ （5/43）] （P ＜0.05）.术后并发症发生率2组间差异无统计学意义（P＞0.05）.多元回归分析显示,术后动脉血乳酸水平增高和气管切开是导致鼻饲患者肺部感染的独立危险因素（P＜0.05）.结论 急性主动脉夹层术后鼻饲合并肺部感染的患者医院病死率明显增高,术后动脉血乳酸水平增高和气管切开的鼻饲患者肺部感染的危险性增加,革兰阴性杆菌是主要病原菌.

Objective To explore the characteristics and risk factors of pulmonary infection in patients with nasal feeding after acute aortic dissection operation.Methods Clinical and bacteriology data of 72 patients with nasal feeding after acute aortic dissection operation from February 2010 to May 2013 were retrospectively analyzed.The patients were divided into pulmonary infection group and non-pulmonary infection group.The postoperative lactic acid level,postoperative complications,intensive care unit （ICU） time,length of trachea intubation time,length of hospital stay and death were recorded and compared between the two groups.Results The incidence of pulmonary infection was 40.3% （29/72）.The mortality of pulmonary infection group was significantly higher than that of non-pulmonary infection group [27.6% （8/29） vs 9.3% （4/43）] （P 〈 0.01）.Totally 62 strains were separated,including 40 strains of gram-negative bacilli （64.5%）,14 strains of gram-positive （22.6%） and 8 strains of fungus （12.9%）.The ICU time,length of trachea intubation time and length of hospital stay were significantly longer,meanwhile the postoperative lactic acid level and incidence of tracheotomy were significantly higher in pulmonary infection group compared with those in non-pulmonary infection group [（12-± 7） d vs （6±2） d,（8±6） d vs （5 ±1） d,（35 ±20） d vs （20 ±8） d 6,（7.5 ±4.2） mmol/L vs （5.4 ± 3.6） mmol/L,48.3% （14/29） vs 11.6% （5/43）] （P 〈 0.01 or P 〈 0.05）.Logistic regression analysis showed that the increased lactic acid level and tracheostomy after operation were independent risk factors of pulmonary infection （P 〈0.05）.Conclusion The hospital mortality is significantly increased in nasal feeding patients complicated with pneumonia after acute aortic dissection operation ; the increased blood lactic acid level and tracheostomy are independent risk factors of pneumonia; the gram-negative bacilli are main pathogens.