小儿先天性心脏病术后呼吸机相关性肺炎发生的危险因素分析

Risk factors of ventilator-associated pneumonia in children after congenital heart disease surgery

目的分析影响小儿先天性心脏病(CHD)患儿术后发生呼吸机相关性肺炎(VAP)的相关危险因素。方法回顾性选取2019年1月至2021年4月于西北妇女儿童医院就诊的360例CHD患儿作为研究对象,根据患儿术后VAP的发生情况分为VAP组(n=78)和非VAP组(n=282),收集两组患儿的临床资料、手术及预后情况,单因素分析影响术后VAP发生的相关因素,再采用多因素Logistic回归分析影响术后VAP发生的独立危险因素。结果VAP组患者中15例死亡,死亡率为19.23%,非VAP组6例死亡,死亡率为2.13%;单因素分析结果显示,RACHS-1分级结果>Ⅱ级、手术总时长>120 min、术中体外循环持续时长>100 min、主动脉阻断时间>30 min、术中输血量>150 mL、延迟关胸、术后使用抑酸剂时长>3 d、术后乳糜胸、术后引流时间>3 d、二次开胸、呼吸机使用时间>4 d、ICU治疗时间>7 d、住院总天数>7 d的CHD患儿VAP发生率更高(P<0.05);多因素Logistic回归分析结果显示,术中体外循环>100 min、术中输血量>150 mL、术后使用抑酸剂>3 d、呼吸机使用时间4 d是CHD患儿术后发生VAP的危险因素(P<0.05)。结论术中体外循环>100 min、术中输血量>150 mL、术后使用抑酸剂>3 d、呼吸机使用时间>4 d均为影响CHD患儿术后发生VAP的独立危险因素,临床可通过针对此类患儿采取应对措施,减少术后VAP的发生率。

Objective To study and analyze the risk factors of ventilator-associated pneumonia(VAP)in children after congenital heart disease(CHD)surgery.Methods A total of 360 children with CHD treated in Northwest Women and Children's Hospital between January 2019 and April 2021 were enrolled as the research objects.According to presence or absence of postoperative VAP,they were divided into VAP group(n=78)and non-VAP group(n=282).The clinical data,surgery,and prognosis information in two groups were collected.Single factor analysis was used to analyze the related factors affecting the occurrence of postoperative VAP,and multivariate logistic regression was used to analyze the independent risk factors affecting the occurrence of postoperative VAP.Results Fifteen patients(19.23%)in VAP group and 6 patients(2.13%)in non-VAP group died.The results of univariate analysis showed that the incidence of VAP was higher in children with RACHS-1 classification results>gradeⅡ,total operative time>120 min,duration of intraoperative extracorporeal circulation>100 min,duration of aortic block>30 min,intraoperative blood transfusion>150 mL,delayed chest closure,usage of acid inhibitiors>3 d,postoperative celiac chest,duration of postoperative drainage>3 d,secondary chest opening,duration of ventilator use>4 d,duration of ICU treatment>7 d,and total hospitalization days>7 d(P<0.05).Multivariate Logistic regression analysis showed that duration of intraoperative extracorporeal circulation>100 min,intraoperative blood transfusion volume>150 mL,postoperative usage of acid inhibitors>3 d and duration of ventilator use>4 d were independent risk factors of VAP(P<0.05).Conclusion Intraoperative cardiopulmonary circulation>100 min,intraoperative blood transfusion>150 mL,postoperative usage of acid inhibitors>3 d and duration of ventilator use are independent risk factors of postoperative VAP in CHD children.Clinically,corresponding measures can be taken based on the above factors to reduce the incidence of postoperative VAP.