老年主动脉夹层患者术后肺炎发生的相关危险因素分析

Analysis of Related Risk Factors for Postoperative Pneumonia in Elderly Patients with Aortic Dissection

目的研究60岁以上老年主动脉夹层患者术后肺炎发生的独立危险因素,为预防术后肺炎发生提供依据。方法选取某三甲医院心脏大血管外科2016年5月-2018年5月收治的年龄≥60岁的主动脉夹层患者为调查对象,采用自行设计的问卷收集患者的相关信息,术后资料包括呼吸机使用时间,术后是否连续发热等。采用t检验、单因素分析及多因素Logistic回归分析方法得出术后肺炎发生的相关危险因素。结果322例老年主动脉夹层患者中,64例发生术后肺炎,感染发生率为19.88%;多因素Logistic回归分析证实,急诊手术(OR=5.174,95%CI=5.143~5.541)、平均手术时间(OR=7.158,95%CI=6.587~8.165)、术中体外循环时间(OR=3.534,95%CI=3.213~4.174)、术后重症监护病房滞留时间>10 d(OR=3.137,95%CI=3.112~3.754)、呼吸机使用时间>3 d(OR=2.781,95%CI=2.315~2.816)、纤支镜使用次数>5(OR=1.456,95%CI=1.193~1.511)以及术后连续发热>5 d(OR=1.524,95%CI=1.036~2.174)均是老年主动脉夹层患者术后肺炎发生的独立危险因素。结论老年主动脉夹层患者易发生术后肺炎,相关影响因素多,应加强对患者的密切观察,针对相关风险因素采取有效防控措施,最终降低感染发生。

Objective To investigate the independent risk factors for postoperative pneumonia in elderly patients with aortic dissection,and provide effective prevention and control measures to reduce the postoperative pneumonia.Methods The patients with aortic dissection aged≥60 years and who were admitted to the department of cardiovascular surgery of a tertiary hospital from May 2016 to May 2018 were selected as the survey subjects.A self-designed questionnaire was used to collect relevant information of the patients.Intraoperative data included operation time,extracorporeal circulation time,etc.Postoperative data included ventilator use time,whether there was contin-uous fever after operation,etc.T-test,single factor analysis and multivariate logistic regression were used to analyze the related risk factors of postoperative pneumonia.Results 64 of the 322 elderly patients with aortic dissection developed postoperative pneumonia and the incidence of infection was 19.88%.Multivariate logistic regression analysis confirmed the emergency surgery(OR=5.174,95%CI=5.143~5.541),average operation time(OR=7.158,95%CI=6.587~8.165),intraoperative extracorporeal circulation time(OR=3.534,95%CI=3.213~4.174),postopera-tive intensive care unit Residence time>10 d(OR=3.137,95%CI=3.112~3.754),ventilator use time>3 d(OR=2.781,95%CI=2.315~2.816),number of times of bronchoscopy use>5(OR=1.456,95%CI=1.193~1.511)and postoperative continuous fever>5 days(OR=1.524,95%CI=1.036~2.174)were independent risk factors for postoperative pneumonia in elderly patients with aortic dissection Conclusion Postoperative pneumonia is prone to occur among elderly patients with aortic dissection,and risk factors are various.Closely observation and effective prevention measures should be taken to reduce the incidence of nosocomial infection.