心脏瓣膜术后肺部感染危险因素分析及预防策略

Analysis of risk factors and prevention strategies for pulmonary infection after heart valve surgery

目的 分析心脏瓣膜术后肺部感染的病原菌分布、危险因素及预防策略。方法 回顾性分析自2020年7月至2021年2月行心脏瓣膜置换或修复术的436例患者的临床资料,根据术后是否出现肺部感染将患者分为感染组(n=41)与非感染组(n=395)。采用单因素分析和多因素Logistic回归分析心脏瓣膜术后肺部感染的危险因素。结果 41例患者确诊为术后肺部感染,发生率为9.4%(41/436)。共分离出病原菌52株,其中,革兰阳性菌14株,革兰阴性菌37株,真菌1株。单因素分析提示,心脏瓣膜术后肺部感染与年龄、吸烟史、糖尿病、肾功能不全、术前心功能分级、体外循环时间、主动脉阻断时间、输血、机械通气时间等因素相关(P<0.05)。多因素Logistic回归分析显示,肾功能不全(OR=2.707,P=0.001)、术前心功能Ⅲ~Ⅳ级(OR=1.466,P=0.006)、体外循环时间≥140 min(OR=1.784,P=0.004)、输血(OR=2.587,P=0.001)、机械通气时间≥48 h(OR=3.740,P=0.001)是心脏瓣膜术后发生肺部感染的独立危险因素。结论 心脏瓣膜术后肺部感染发生率较高,病原菌以革兰阴性菌为主。肾功能不全、术前心功能Ⅲ~Ⅳ级、体外循环时间、输血、机械通气时间是术后肺部感染的危险因素,临床上应采取相应措施进行预防,以期降低心脏瓣膜术后感染风险,改善预后。

Objective To analyze the pathogen distribution,risk factors and prevention strategies for pulmonary infection after heart valve surgery.Methods A total of 436 patients with heart valve replacement or repair surgery from July 2020 to February 2021 were retrospectively analyzed and divided into infection group(n=41)and non⁃infection group(n=395)according to the occurrence of pulmonary infection after heart valve surgery.Univariate and multivariate Logistic regression analysis were used to identify the risk fac⁃tors.Results There were 41 cases(9.4%)postoperative pulmonary infection.Totally 52 pathogenic strains were isolated,including 14 Gram⁃positive bacteria,37 Gram⁃negative bacteria and 1 fungus.The risk factors of postoperative pulmonary infection included age,smoking history,diabetes,renal dysfunction,preoperative cardiac function grade,cardiopulmonary bypass time,aortic blockade time,blood transfusion and mechanical ventilation time(P<0.05).Multivariate Logistic regression showed that renal insufficiency(OR=2.707,P=0.001),preoperative poor cardiac function(OR=1.466,P=0.006),cardiopulmonary bypass time≥140 min(OR=1.784,P=0.004),blood transfusion(OR=2.587,P=0.001),mechanical ventilation time≥48 h(OR=3.740,P=0.001)were in⁃dependent predictors of pulmonary infection after heart valve surgery.Conclusion The incidence of pulmonary infection after heart valve is high and main pathogens are Gram⁃negative bacteria.Renal insufficiency,preoperative poor cardiac function,cardiopulmonary bypass time,blood transfusion and mechanical ventilation time are independent risk factors for postoperative pulmonary infection,and clinical measures should be taken to reduce the risks for pulmonary infection after heart valve surgery and improve the prognosis.