老年瓣膜置换术后重症肺炎的易感因素和治疗分析

目的 探讨老年心脏瓣膜病患者接受换瓣手术后发生肺炎的易感因素及治疗方法.方法 对2002年1月至2009年5月收治的246例60岁以上的老年心脏瓣膜病患者接受换瓣手术后发生重症肺炎的病例进行回顾性分析.结果 发生重症肺炎27例（11.0%）.单因素分析发现,手术前年龄、慢性肺部疾病史、心脏手术史、手术前左室射血分数、多瓣膜置换、手术升主动脉阻断时间、合并冠脉搭桥手术、术后24 h输血量等因素与手术后发生肺炎相关.多因素logistic回归分析发现,慢性肺部疾病史、合并冠脉手术、手术后24 h输血量≥2000 ml是老年患者换瓣手术后重症肺炎的独立危险因素.病原学检查以革兰阴性菌为主.结论 老年瓣膜置换手术后的肺部感染是多因素作用的结果,减少其发生率应始于术前,严于术中,善于术后.

The predisposing factor and treatment of cardiac valve replacement in elderly patients with severe pneumonia

Objective To study the predisposing factors and treatment of severe pneumonia in elderly patients who accepted cardiac valve replacement. Methods 246 cases of severe pneumonia in patients aged over 60 who had undergone heart valve prosthesis replacement between January 2002 and May 2009 in our hospital were retrospective analyzed. Results The rate of severe pneumonia was 11%（27 cases）. Single factor analysis showed that risk factors, such as age, history of chronic pulmonary disease and cardiosurgery, left ventricular ejection fraction, multiple valve replacement, ascending aortic blocking time, accompanied with CABG surgery, 24 hours- volume of blood transfusions after the operation, were related to severe pneumonia. However, multiple factor Logis- tic regression analysis showed that history of chronic pulmonary disease, accompanied with coronary surgery, 24 hours-volume of blood transfusions over 2000 ml were independent risk factors of severe pneumonia in elderly pa- tients who accepted cardiac valve replacement, Pathogenic examination showed most of the bacteria were Gram neg- ative bacteria. Conclusion Severe pneumonia in elderly patients who accepted cardiac valve replacement is caused by multiple factors. To reduce the incidence rate, we should be careful before the operation, and strict during the process and perfect in the post period.