主动脉夹层患者术后呼吸机相关肺炎的危险因素分析

Analysis of Risk Factors for Ventilator-Associated Pneumonia in Patients With Aortic Dissection

目的分析主动脉夹层(aortic dissection,AD)患者术后呼吸机相关肺炎(ventilator associated pneumonia,VAP)发生的危险因素,并探究预防措施。方法回顾性分析2021年3月—2022年3月南华大学附属第二医院收治的296例AD患者的临床资料。通过医院电子病例数据库检索诊断为AD且顺利完成手术的患者,根据术后是否发生VAP分为VAP组和N-VAP组。采用单因素分析筛选出差异有统计学意义的肺炎相关危险因素作为自变量,以患者术后是否发生VAP为因变量进行多因素logistic回归分析,筛选危险因素。结果本研究共纳入296例AD患者,其中术后发生VAP的患者43例,VAP发病率为14.53%;VAP组与N-VAP组是否急诊、通气时间、手术时间、是否多次气管插管、发病至手术时间比较,差异有统计学意义(P<0.05)。以AD患者术后是否出现VAP为因变量,单因素分析有差异的是否急诊、通气时间、手术时间、是否多次气管插管、发病至手术时间为自变量进行多因素logistic回归分析,结果显示,通气时间延长、手术时间≥5 h、有多次气管插管是AD患者术后出现VAP的危险因素(P<0.05)。结论本研究对AD患者术后VAP发生的影响因素进行初步评估,其中通气时间较长、多次气管插管及手术时间≥5 h是AD患者术后VAP发生的危险因素。

Objective To analyze the risk factors of postoperative ventilator-associated pneumonia(VAP)in patients with aortic dissection(AD)and explore preventive measures.Methods The clinical data of 296 AD patients admitted to the Second Hospital University of South China from March 2021 to March 2022 were analyzed retrospectively.The patients diagnosed as AD and successfully completed the operation were retrieved from the hospital electronic case database,and were grouped into VAP group and N-VAP group according to whether VAP occurred after the operation.The obvious risk factors related to pneumonia were screened by univariate analysis as the independent variable,and the dependent variable was whether the patient had VAP after operation,multivariate logistic regression analysis was performed to screen risk factors.Results A total of 296 AD patients were included in this study,among them,43 patients had VAP after operation,and the incidence rate of VAP was 14.53%.There were obvious differences between VAP group and N-VAP group in terms of emergency,ventilation time,operation time,multiple tracheal intubation and the time from onset to operation(P<0.05).Taking the occurrence of VAP in AD patients after surgery as the dependent variable,taking indicators with differences in univariate analysis:whether emergency,ventilation time,operation time,whether multiple tracheal intubation,and the time from onset to operation,as independent variables,multivariate logistic regression analysis was conducted,and the results showed that prolonged ventilation time,operation time≥5 hours,and multiple tracheal intubation were the risk factors for the occurrence of VAP in AD patients after surgery(P<0.05).Conclusion This study preliminarily evaluated the risk factors of postoperative VAP in AD patients,among which long ventilation time,multiple tracheal intubation and operation time≥5 hours were the risk factors of postoperative VAP in AD patients.