Stanford A型主动脉夹层术后VAP危险因素

目的 探讨Stanford A型主动脉夹层患者术后发生呼吸机相关肺炎(VAP)的危险因素.方法 回顾性收集某院2019年1—12月Stanford A型主动脉夹层手术患者的资料.其中发生VAP的患者为VAP组,非VAP组以1:3进行匹配,分析VAP的危险因素.结果 2019年1—12月共收治161例Stanford A...

Risk facrtos for ventilator-associated pneumonia after Stanford type A aortic dissection surgery

Objective To investigate the risk factors for ventilator-associated pneumonia (VAP) after Stanford type A aortic dissection surgery. Methods Data of patients undergoing Stanford type A aortic dissection surgery from January to December in 2019 were collected retrospectively. Patients with VAP were in VAP group, non-VAP group were 1:3 matched to analyze the risk factors of VAP. Results From January to December in 2019, there were 161 patients with Stanford type A aortic dissection were admitted in hospital and 112 patients were included in study. There were 28 cases of VAP, case infection rate was 17.39%. The total ventilator utilization days was 734 days, infection rate of VAP per 1 000 ventilator-day was 38.14‰. Univariate analysis showed that duration of deep hypothermic circulatory arrest, post-operative ventilator utilization and omeprazole use as well as blood creatinine level in VAP group were all higher than in non-VAP group (all P<0.05); proportion of post-operative severe hypoxemia and renal failure in VAP group were all higher than in non-VAP group (all P<0.05). Logistic multivariate regression analysis showed that duration of post-operative ventilator utilization, post-operative severe hypoxemia, blood creatinine level, and continuous renal replacement therapy were independent risk factors for VAP. The area under receiver operating characteristic (ROC) curve of blood neutrophil, white blood cell count, procalcitonin and body temperature were 0.60, 0.73, 0.77 and 0.70 respectively. Elevated white blood cell count, procalcitonin and body temperature could assist in the diagnosis of VAP. The main pathogen of VAP was Klebsiella pneumoniae (23 strains), 22 of which were carbapenem-resistant Klebsiella pneumoniae. Conclusion Shortening the duration of ventilator utilization, reducing post-operative severe hypoxemia and decreasing post-operative renal failure can reduce the incidence of post-operative VAP in patients with Stanford type A aortic dissection. White blood cell count, procalcitonin and body temperature can be used for early auxiliary diagnosis of VAP.