成人心脏手术后呼吸机相关肺炎的危险因素

目的 探讨成人心脏手术后呼吸机相关肺炎(VAP)的危险因素。方法 回顾性收集某院2017年1月—2021年5月心脏外科重症监护病房(ICU)接受胸骨切开术的成人心脏手术患者病历资料。选取术后发生VAP患者为病例组，按照1∶1进行病例-对照匹配。采用单因素及多因素logistic回归分析VAP感染的危险因素。结果 共有5 919例成人心脏手术患者术后使用呼吸机，其中766例患者呼吸机使用时间>48 h。62例患者发生VAP,发病率1.05%,8.03例/1 000机械通气日，成功匹配61例。多因素分析结果显示，术前肌酐≥1.1 mg/dL、手术时间≥7.33 h及术后意识障碍是成人心脏手术后VAP的独立危险因素。感染病原菌以革兰阴性菌为主(54株，90.0%),检出率最高为鲍曼不动杆菌(24株，40.0%)。VAP患者消化道出血、鼻饲和急性肾损伤风险明显升高，ICU住院时长、住院费用及病死率明显增加(均P<0.01)。结论 术前改善肾功能、缩短手术时间及减少术后意识障碍可降低成人心脏手术后VAP发病率。

Risk factors for ventilator-associated pneumonia following cardiac surgery in adults

Objective To explore risk factors for ventilator-associated pneumonia (VAP) following cardiac surgery in adults. Methods Medical records of adult patients undergoing cardiac surgery through sternotomy in a hospital between January 2017 to May 2021 were collected retrospectively. Patients with VAP after surgery were selected as case group, case-control matching was conducted according to 1:1 matching. Univariate and multivariate logistic regression analysis were performed for the risk factors of VAP. Results A total of 5 919 cardiac surgery adult patients used ventilators after operation, 766 of whom used ventilator for more than 48 hours. 62 patients had VAP, incidence was 1.05%, 8.03 cases/1 000 mechanical ventilation days, and 61 cases were successfully matched. Multivariate analysis showed that pre-operative creatinine ≥ 1.1 mg/dL, duration of operation ≥ 7.33 hours and post-operative disturbance of consciousness were independent risk factors for VAP after cardiac surgery in adults. The pathogen of infection was mainly Gram-negative bacteria (54 strains, 90.0%), Acinetobacter baumannii had the highest isolation rate (24 strains, 40.0%). The risk for gastrointestinal hemorrhage, nasogastric tubing and acute kidney injury in VAP patients significantly increased, and the length of ICU stay, hospitalization cost and mortality significantly increased (all P<0.01). Conclusion Improving renal function before operation, shortening duration of surgery and reducing post-operative disturbance of consciousness can reduce the incidence of VAP after cardiac surgery in adults.