CAJ | 학술논문

目的探讨小儿体外循环心脏术后呼吸机相关性肺炎(ventilator-associated pneu monia,VAP)的危险因素.方法对2003年1月至2010年6月连续体外循环(cardiopulmonany bypass,CPB)心脏术后机械通气时间超过48 h的116例患儿的临床资料进行回顾性分析,根据发生VAP与否进行分组,并进行术后VAP的单因素和多因素Logistic回归分析.结果CPB心脏术后VAP总发病率为4.18％(57/1 365),发生VAP患儿病死率为26.32％(15/57).单因素分析显示:重度肺动脉高压、CPB时间、主动脉阻断时间、二次体外循环支持、白蛋白、术后PaO2/FiO2、机械通气时间、每千克体质量引流液总量、二次气管插管、气管切开、留置胃管、应激性溃疡预防用药与术后发生VAP有关.经多因素Logistic回归分析显示:CPB时间≥150m in、机械通气时间≥4 d、每千克体质量引流液总量≥18ml和气管切开为小儿CPB术后发生VAP的危险因素.57例VAP患儿中共培养病原菌90株,其中革兰阴性菌54株(60.0％),革兰阳性菌32株(35.6％),真菌4株(4.4％).结论临床上可根据VAP的危险因素预先采取措施,以减少VAP的发生.
목적 탐토소인체외순배심장술후호흡궤상관성폐염(ventilator-associated pneu monia,VAP)적위험인소.방법대2003년1월지2010년6월련속체외순배(cardiopulmonany bypass,CPB)심장술후궤계통기시간초과48 h적116례환인적림상자료진행회고성분석,근거발생VAP여부진행분조,병진행술후VAP적단인소화다인소Logistic회귀분석.결과CPB심장술후VAP총발병솔위4.18％(57/1 365),발생VAP환인병사솔위26.32％(15/57).단인소분석현시:중도폐동맥고압、CPB시간、주동맥조단시간、이차체외순배지지、백단백、술후PaO2/FiO2、궤계통기시간、매천극체질량인류액총량、이차기관삽관、기관절개、류치위관、응격성궤양예방용약여술후발생VAP유관.경다인소Logistic회귀분석현시:CPB시간≥150m in、궤계통기시간≥4 d、매천극체질량인류액총량≥18ml화기관절개위소인CPB술후발생VAP적위험인소.57례VAP환인중공배양병원균90주,기중혁란음성균54주(60.0％),혁란양성균32주(35.6％),진균4주(4.4％).결론림상상가근거VAP적위험인소예선채취조시,이감소VAP적발생.
Objective To analyze the risk factors for ventilator-associated pneumonia(VAP)in children after cardiopulmonary bypass(CPB).Methods Between January 2003 and June 2010,116 consecu tive cases receiving postoperative ventilation for more than 48 hours were included in this study.The patients were assigned into a VAP group(n =57)and non-YAP group(n =59).Univariate and multivariate logistic regression analysis were used to identify the risk factors.Results The overall incidence of VAP was 4.18％(57/1 365).The mortality of VAP was 26.32％(15/57).Univariate risk factors included severe pulmonary hypertension,CPB time,aortic cross-clamping time,secondary CPB support,plasma albumin,low ratio of ar terial oxygen tension to inspired oxygen fraction(PaO2/FiO2),mechanical ventilation time,the volume of postoperative drainage per kilogram of body weight,re-intubations,tracheotomy,gastric tube retention,pre vention of stress ulcer.Multivariate logistic regression analysis showed that risk factors included CPB time≥150 min,mechanical veritilation time ≥4 d,the volume of postoperative drainage per kilogram of body weight ≥ 18 ml and tracheotomy.A total of 90 pathogens were obtained by sputum culture in 57 VAP patients.There were 54 cases(60.0％)gram negative bacilli,32 cases(35.6％)of gram positive bacilli and 4 cases (4.4％)of eumycetes.Conclusion These results suggest that the patients with risk factors described above need more careful and postoperative surveillance and management.