COPD患者冠状动脉旁路移植术后肺部感染的预后影响及危险因素分析

Prognostic influence and risk factors of pneumonia after coronary artery bypass transplantation in patients with COPD

目的 分析慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)患者接受冠状动脉旁路移植术(coronary artery bypass grafting, CABG)术后发生肺部感染的危险因素及其对预后的影响。方法 回顾性分析2021年1月至2021年12月首都医科大学附属北京安贞医院收治的CABG手术的COPD患者临床资料,按照术后住院期间是否发生肺部感染,分为观察组75例及对照组143例,对其术前、术后的临床资料进行分析,以分析肺部感染的预后影响及危险因素。结果 共纳入218例患者,术后肺部感染的发生率为75例(34.40%)。观察组术后住院时间平均延长1.81 d(P<0.001);30 d及1年病死率组间无统计学差异。多元二分类Logistic回归分析显示,第一秒用力呼气容积(FEV_(1)%)与CABG术后肺部感染发生率负相关(OR=0.938,95%CI:0.881~0.998,P<0.05),年龄≥65岁(OR=4.027,95%CI:2.101~7.719,P<0.001)、FEV_(1)≤60%(OR=9.255,95%CI:2.328~36.794,P=0.002)是术后发生肺部感染的危险因素。结论 CABG术后发生肺部感染会延长住院时间,对30 d及1年病死率无影响。年龄≥65岁、FEV_(1)≤60%是COPD患者CABG术后发生肺部感染的危险因素。

Objective To investigate the risk factors of pneumonia after coronary artery bypass grafting(CABG)in patients with chronic obstructive pulmonary disease(COPD)and its influence on prognosis.Methods The clinical data of COPD patients undergoing CABG surgery admitted to Beijing Anzhen Hospital Affiliated to Capital Medical University from January 2021 to December 2021 were retrospectively analyzed.According to whether postoperative pneumonia occurred during the postoperative hospitalization,the patients were divided into observation group 75 cases and control group 143 cases.The preoperative and postoperative clinical data were analyzed to explore the risk factors of pneumonia.Results A total of 218 patients were included,ranging in age from 45 to 76 years,with an average age of(64.81±7.72)years,including 149 males(68.35%).The incidence of postoperative pulmonary infection was 75 cases(34.40%).The average length of postoperative hospital stay in the observation group was extended by 1.81 days(P<0.001),but there was no significant difference in mortality at 30 days and within 1 year between the two groups.Multivariate binary Logistic regression analysis showed that FEV_(1)%was negatively correlated with the incidence of postoperative pneumonia of CABG(OR=0.938,95%CI:0.881~0.998,P<0.05).Age≥65 years old(OR=4.027,95%CI:2.101~7.719,P<0.001),forced expiratory volume in the first second(FEV_(1))≤60%(OR=9.255,95%CI:2.328~36.794,P=0.002)were risk factors for postoperative pneumonia.Conclusions Pulmonary infection after CABG surgery prolonged hospital stay and had no effect on 30 d and 1-year mortality.Age≥65 years and FEV_(1)≤60%are risk factors for pulmonary infection after CABG in COPD patients.