心脏瓣膜置换术后呼吸机相关性肺炎的危险因素分析

目的 探讨心脏瓣膜置换术后呼吸机相关性肺炎（VAP）的危险因素.方法 对我院收治的98例心脏瓣膜置换术后机械通气超过48 h患者的临床资料进行分析.结果 分析显示围术期输血量、体外循环时间、主动脉阻断时间、机械通气时间、术前左室射血分数（LVEF）、术后氧合指数（PaO2/FiO2）、ICU住院天数、双瓣置换术、重度肺动脉高压、气管切开、再次插管、应用抑酸剂、术后死亡率13个因素与VAP有关（P＜0.05）.Logistic多因素回归分析显示体外循环时间≥120 min、机械通气时间≥4 d、再次插管、应用抑酸剂4个因素是VAP发生的危险因素.结论 围手术期尽量避免危险因素,以减少VAP的发生.

Analysis of risk factors of ventilator-associated pneumonia after the replacement of cardiac valve

Objective To analyze the risk factors of ventilator-associated pneumonia （VAP） after the replacement of cardiac valve. Methods 98 patients received the replacement of cardiac valve were given mechanical ventilation more than 48 hours postopera- tively, and their clinical data were retrospectively analyzed. Results The single-factor analysis showed that the occurrence of VAP was related with perioperative blood transfusion, duration of extracorporeal circulation, block time of aorta, duration of mechanical ventilation, left ventricular ejection fraction （LVEF）, postoperative oxygenation index （PaOz/FiOz ）, duration of hospital stay in ICU, double valve replacement surgery, severe pulmonary hypertension, tracheotomy, re-intubation, application of antacids, and postoperative mortality （P 〈 0. 05 ）. The multi-factors of Logistic analysis showed that the risk factors of VAP included extracorporeal circulation time longer than 120 min, ventilation time longer than 4 days, re-intubation and application of antacids. Conclusion The patients received the replacement of cardiac valve should avoid perioperative risk factors in order to reduce the incidence of VAP.