心脏外科术后患者肺部感染危险因素的系统评价与Meta分析

Risk factors for pulmonary infection in patients after cardiac surgery:A systematic review and meta-analysis

目的系统评价心脏外科术后患者发生肺部感染的危险因素。方法计算机检索中国知网、万方、维普、中国生物医学文献数据库、PubMed、The Cochrane Library、EBSCO、CINAHL、Web of Science、EMbase数据库中有关心脏外科术后患者肺部感染危险因素的文献,检索时限为建库至2023年8月。由2名研究人员按照纳入与排除标准独立筛选和评价文献,采用纽卡斯尔-渥太华量表(Newcastle-Ottawa Scale,NOS)对文献进行质量评价。采用RevMan 5.4软件进行Meta分析。结果最终纳入23篇文献,共24348例患者,其中21篇病例对照研究,2篇队列研究,NOS评分均≥6分。Meta分析结果显示:年龄[OR=2.16,95%CI(1.80,2.59),P<0.001]、吸烟史[OR=1.91,95%CI(1.67,2.18),P<0.001]、合并肺部疾病[OR=1.61,95%CI(1.40,1.85),P<0.001]、糖尿病[OR=1.62,95%CI(1.26,2.08),P<0.001]、手术时间[OR=2.54,95%CI(1.86,3.46),P<0.001]、体外循环[OR=3.78,95%CI(2.11,6.77),P<0.001]、体外循环时间[OR=2.30,95%CI(1.94,2.71),P<0.001]、输血[OR=2.55,95%CI(2.04,3.20),P<0.001]、机械通气时间[OR=2.78,95%CI(2.34,3.30),P<0.001]、气管插管时间[OR=3.93,95%CI(2.45,6.31),P<0.001]、再次气管插管[OR=8.74,95%CI(4.17,18.30),P<0.001]为心脏外科术后患者肺部感染的独立预测因素。结论年龄、吸烟史、合并肺部疾病、糖尿病、手术时间、体外循环时间、输血、机械通气时间、气管插管时间及再次气管插管是心脏外科术后患者肺部感染的预测因素。

Objective To systematically evaluate the risk factors for pulmonary infection after cardiac surgery.Methods A computer search was performed to collect researches on risk factors for pulmonary infection in patients after cardiac surgery from the databases,including CNKI,Wanfang,VIP,CBM,PubMed,The Cochrane Library,EBSCO,CINAHL,Web of Science,EMbase from the inception to August 2023.Two researchers independently extracted data and assessed the literature according to the inclusion and exclusion criteria,and the quality of the literature was evaluated using the Newcastle-Ottawa Scale(NOS).The meta-analysis was performed using RevMan 5.4 software.Results A total of 23 studies covering 24348 patients were selected,including 21 case-control studies and 2 cohort studies.The NOS scores were≥6 points.The results of meta-analysis showed that age(OR=2.16,95%CI 1.80 to 2.59,P<0.001),smoking history(OR=1.91,95%CI 1.67 to 2.18,P<0.001),pulmonary disease(OR=1.61,95%CI 1.40 to 1.85,P<0.001),diabetes mellitus(OR=1.62,95%CI 1.26 to 2.08,P<0.001),operation time(OR=2.54,95%CI 1.86 to 3.46,P<0.001),cardiopulmonary bypass(CPB)(OR=3.78,95%CI 2.11 to 6.77,P<0.001),CPB time(OR=2.30,95%CI 1.94 to 2.71,P<0.001),blood transfusion(OR=2.55,95%CI 2.04 to 3.20,P<0.001),postoperative mechanical ventilation time(OR=2.78,95%CI 2.34 to 3.30,P<0.001),tracheal intubation time(OR=3.93,95%CI 2.45 to 6.31,P<0.001)and repeated tracheal intubation(OR=8.74,95%CI 4.17 to 18.30,P<0.001)were independent risk factors for pulmonary infection in patients after cardiac surgery.Conclusion Age,smoking history,pulmonary disease,diabetes mellitus,operation time,CPB,CPB time,blood transfusion,postoperative mechanical ventilation time,tracheal intubation time,and repeated tracheal intubation are risk factors for pulmonary infection in patients after cardiac surgery.It can be used as a reference to strengthen perioperative evaluation and nursing of high-risk patients and reduce the incidence of pulmonary infection.