心脏病术后呼吸机相关性肺炎的相关因素及病原菌特点分析

Analysis of related factors and pathogen characteristics of ventilator-associated pneumonia after cardiac surgery

目的:探讨我院心脏术后患者呼吸机相关性肺炎(VAP)的危险因素及病原菌分布特征。方法:对2014年1月至2017年9月,我院心脏病术后机械通气的108例患者的临床资料进行回顾性分析。结果:108患者VAP出现37例,发生率35. 2%,分离出51株病原菌,分别为:革兰阴性菌28株占 54. 9%、革兰阳性菌19株占37. 3%、真菌4株占7. 8%。心脏病术后行机械通气治疗的患者发生VAP与年龄、体外循环时间、术后机械通气时间、有无基础病、延迟关胸、术后有无合并肺不张、不合理应用抗生密切相关;与患者性别,手术种类无相关。结论:VAP的发生率与病原菌分布地区差异较大,有效的缩短体外循环及机械通气时间、预防术后胸腔积液及合理应用抗生素,是减少心脏术后VAP发生率的主要策略。

Objective : To investigate the risk factors and pathogen distribution characteristics of venti-lator-associated pneumonia (VAP) in patients after cardiac surgery in our hospital. Methods: To analyzed the clinical data of 108 patients with ventilator-associated pneumonia after cardiac surgery in our hospital from Janu-ary 2014 to September 2019. Results: 37 of 108 patients with VAP, the incidence rate was 35. 18%, 51 strains of pathogens were isolated, respectively: 28 strains of Gram-negative bacteria accounted for 54. 90%, 19 strains of Gram-positive bacteria accounted for 37. 25%, and 4 strains of fungi accounted for 7. 84%. Patients with me-chanical ventilation after cardiac surgery with VAP closely related with age, cardiopulmonary bypass time, post-operative mechanical ventilation time, presence or absence of underlying disease, delayed chest closure, post-operative atelectasis, and irrational application of antibiotics, unrelated with the patients gender and the type of surgery. Conclusions: The incidence of VAP and pathogenic bacteria distribution area differences, the main strategies to reduce the incidence of postoperative VAP are shortening the time of cardiopulmonary bypass and mechanical ventilation, preventing postoperative pleural effusion and rational application of antibiotics.