摘要
目的:观察大管外科术后医院获得性肺炎(HAP)患者的病情变化及结果,分析影响肺炎转归的相关因素。方法:2009年6月至2011年5月,我院大血管术后HAP病例38例。男性26例,女性12例;平均年龄(51.4±11.6)岁。诊断:A型夹层21例;B型夹层5例;主动脉根部瘤+AI 12例。手术类型:升主动脉+全弓+支架象鼻术19例;升主动脉+部分弓2例;胸腹主动脉替换术5例;Bentall术11;Wheats 1例。根据HAP病程的不同分为Ⅰ组和Ⅱ组,比较两组围术期的一般情况、术中指标以及术后并发症等相关评价指标。结果:HAP的发生率为4.4%。肺炎的病程平均为15.4 d(5d～50 d)。机械通气时间>10 d(OR=20.667,P<0.001);低心排出量综合征(低心排)(OR=5.5,P=0.038);急性肾衰竭(OR=4.767,P=0.037);多脏器功能衰竭(OR=1.824,P=0.037)是影响术后HAP转归的相关因素。Ⅰ组和Ⅱ组术后呼吸机辅助时间分别为(182.1±84.5)h和(468.6±144.7)h;ICU停留时间分别为(12.1±5.4)d和(31±15.3)d;死亡病例分别为0例和5例,两组间差异有统计学意义(P<0.01)。结论:术后不良事件或并发症的发生对HAP的转归影响显著,导致感染程度加重、病程延长,影响治疗效果,增加死亡风险。
Objective：To observe the clinical and outcome of Hospital-acquired pneumonia（HAP） after aortic surgery.To analyze the related risk factors for the outcome.Methods： Between June 2009 and May 2011,there were 864 consecutive patients who had open repairs of aortic dissection or aneurysm performed.The occurrence of pneumonia was diagnosed on 38 patients [26 male and 12 female,mean aged（51.4±11.6） years] according to HAP diagnosis criteria.Indications for surgical intervention were type A aortic dissection in 21 patients,type B aortic dissection in 5 patients and aortic aneurysm with AI in 12 patients.In detail,ascending aorta and arch repairs combined with stent elephant trunk in 19 patients,ascending aorta and part arch repairs in 2 patients,thoracic and abdominal aorta repairs in 5 patients,Bentalls in 11 patients and Wheats in 1 patient.According to the clinical feature of pneumonia,the patients can be divided into two groups（group Ⅰ and group Ⅱ）.Data were gathered for multiple perioperative factors including age,sex,diagnosis,pulmonary disease,smoking,diabetes,surgical intervention type,low cardiac output,acute renal dysfunction,mechanic ventilation time and death et al.These valuables were recorded and compared statistically between two groups.Results： Postoperative HAP occurred in 38（4.4%） patients.The mean term of pnumonia is 15.4 d（5 d^50 d）.mechanic ventilation time10 d（OR=20.667,P0.001）;low cardiac output（OR=5.5,P=0.038）;acute renal dysfunction（OR=4.767,P=0.037） and multiple organ dysfunction syndrome（OR=1.824,P=0.037） are the risk factors of postoperative pneumonia.The mechanic ventilation time of group I and group Ⅱ are（182.1±84.5）h and（468.6±144.7）h,respectively;ICU retention time were（12.1±5.4）d and（31±15.3）d;death cases were 0 and 5.There were significant difference between two groups on these factors（P0.01）.Conclusion： Adverse events and complications after surgery has a positive association with postoperative HAP,resulting in the degree and course of infection increasing,treatment failure and the risk for death increasing.
出处
《心肺血管病杂志》
CAS
2013年第1期30-33,共4页
Journal of Cardiovascular and Pulmonary Diseases
