中老年心脏瓣膜置换术肺部感染危险因素调查

Study on risk factors of pulmonary infection in middle-aged and elderly patients undergoing cardiac valve replacement

目的 探究中老年心脏瓣膜置换术肺部感染的危险因素和病原菌分布情况。方法 对山东省某三级甲等医院2018年1月1日—2019年12月31日收治的636例中老年心脏瓣膜置换手术患者临床资料进行回顾性分析,采用单因素和多因素logistic回归分析发生肺部感染的危险因素。结果 共纳入636例患者,肺部感染率为20.13%(128例),多因素logistic回归分析结果显示肺部疾病、应激性高血糖、糖皮质激素使用时间、气管插管时间及美国麻醉医师协会(ASA)分级是中老年心脏瓣膜置换术患者发生肺部感染的独立危险因素(P<0.05)。共检出病原菌54株,革兰阴性菌44株(81.48%),其中鲍曼不动杆菌最常见。结论 医务人员应尽早识别中老年心脏瓣膜置换术患者中感染高危患者,积极开展感染防控工作。

Objective To investigate the risk factors and pathogenic bacteria of pulmonary infection in middle-aged and elderly patients undergoing cardiac valve replacement.Methods The clinical data of middle-age and elderly patients who received cardiac valve replacement in a grade A tertiary hospital of Shandong Province from January 1,2018 to December 31,2019 were retrospectively analyzed.Univariate and multivariate Logistic regression analysis were used to analyze the risk factors of pulmonary infection,a 1:l propensity score matching was conduct for patients in infection group and non-infection group.ResultsA total of 636 patients were included,and the pulmonary infection rate was 20.13%(128 cases).Multivariate Logistic regression analysis showed that pulmonary disease,stress hyperglycemia,duration of glucocorticoid use,duration of endotracheal intubation and ASA grade were independent risk factors for pulmonary infection in middle-aged and elderly patients undergoing cardiac valve replacement(P<0.05).A total of 54 strains of pathogens were detected,including 44 strains of gram-negative bacteria(81.48%),of which Acinetobacter baumannii were the most common.Conclusion It is necessary for clinical medical staff to identify patients at high-risk of infection early and take measures actively for infection prevention and control.