风湿性心脏病患者瓣膜置换术后感染的危险因素分析

Risk factors of postoperative infections in patients with rheumatic heart disease after valve replacement

目的探讨风湿性心脏病患者瓣膜置换术后感染的危险因素,以减少术后感染,提高预后效果。方法选择2014年1月-2015年10月医院收治的均接受瓣膜置换治疗的风湿性心脏病患者327例,完整获得患者临床资料,确定是否出现术后感染。结果 327例患者中,有39例出现术后感染,感染率11.93%,50岁以上患者的感染率显著高于其他年龄段,差异有统计学意义（P〈0.05）,其他年龄段之间比较差异无统计学意义,病史在10年以上患者的感染率显著高于5年以内与5-10年的患者,差异有统计学意义（P〈0.05）,5年以内与5-10年的患者之间比较感染率差异无统计学意义,心功能Ⅳ级患者感染率显著高于Ⅱ级、Ⅲ级,P〈0.05。实施单瓣置换术的患者术后感染率显著低于双瓣置换术患者,差异有统计学意义（P〈0.05）;主动脉阻断时间〉120min的患者术后感染率显著高于主动脉阻断时间〈120 min的患者,差异有统计学意义（P〈0.05）,主动脉阻断时间〈60min以及60-120min的患者之间比较感染率差异无统计学意义。结论风湿性心脏病患者接受瓣膜置换术治疗之后存在一定的术后感染风险,相关因素包括年龄和病史以及手术方式等。

OBJECTIVE To investigate the risk factors of postoperative infections in patients with rheumatic heart disease,so as to reduce postoperative infection and improve prognosis of patients with rheumatic heart disease.METHODS A total of 327 cases of patients with rheumatic heart disease underwent valve replacement therapy in our hospital from Jan.2014 to Oct.2015 were chosen,and the complete clinical data were analyzed to determine whether there was infection.RESULTS There were 39 cases of postoperative infections in 327 cases,with the infection rate of 11.93%.The infection rate of patients over 50 years was significantly higher than other age groups（P〈0.05）,and the difference had no significance among other age groups.The infection rate in patients with history of 10 years was significantly higher than that of patients with history of 5-10and 5years（P 0.05）,and the difference was not significant between 5years and 5-10years.The infection rate of patients with grade Ⅳheart function was significantly higher than that of gradeⅡ,Ⅲ（P 0.05）.The infection rate of patients with implementation of single valve replacement was significantly lower than that of double valve replacement patients（P〈0.05）.The infection rate of patients with aortic cross clamping time more than 120 min was significantly higher than that of the aortic cross clamping time less than 120 min（P〈0.05）,and there had no significant difference of infection rate of patients with aortic cross clamping time less than 60 min and 60 - 120 min.CONCLUSION Patients with rheumatic heart disease undergoing valve replacement surgery after treatment have a certain risk of postoperative infection,and its related factors include age,medical history,and surgical procedures,etc.