中华老年多器官疾病杂志
中華老年多器官疾病雜誌
중화노년다기관질병잡지
CHINESE JOURNAL OF MULTIPLE ORGAN DISEASES IN THE ELDERLY
2015年
4期
263-267
,共5页
心脏术后%呼吸机相关性肺炎%临床分析%致病菌
心髒術後%呼吸機相關性肺炎%臨床分析%緻病菌
심장술후%호흡궤상관성폐염%림상분석%치병균
post-cardiac surgery%ventilator-associated pneumonia%clinical analysis%pathogenic bacteria
目的：探讨＞70岁老年患者心脏手术后呼吸机相关性肺炎（VAP）的发病风险及相关病原学特点，以指导临床合理使用抗菌药物。方法回顾性地分析2013年1月至2014年6月南京医科大学附属南京医院心脏外科重症监护病房（ICU）收治的机械通气时间＞48h且年龄＞70岁的老年患者33例，根据是否发生VAP分为VAP组及非VAP组，对两组患者的临床资料进行分析，筛选术后VAP的危险因素、致病菌及相应敏感药物。结果33例患者中共16例患者发生VAP。单因素分析显示，两组之间急性生理与慢性健康评分Ⅱ（APACHE Ⅱ）、主动脉阻断时间、体外循环时间、机械通气时间及ICU住院时间差异有统计学意义（P＜0.01）。多因素回归分析显示，主动脉阻断时间及机械通气时间与VAP发生明显相关。分离病原菌19株，多以革兰阴性杆菌为主（84.2%），其中肺炎克雷伯菌及铜绿假单胞菌是主要致病菌，革兰阳性球菌及真菌发生率较低，万古霉素对革兰阳性球菌抗菌活性为100%。结论老年患者心脏术后VAP的发生与多种因素有关，需提高手术技术缩短主动脉阻断时间，尽早拔管，合理使用抗菌药物，以改善老年患者心脏术后VAP预后。
目的：探討＞70歲老年患者心髒手術後呼吸機相關性肺炎（VAP）的髮病風險及相關病原學特點，以指導臨床閤理使用抗菌藥物。方法迴顧性地分析2013年1月至2014年6月南京醫科大學附屬南京醫院心髒外科重癥鑑護病房（ICU）收治的機械通氣時間＞48h且年齡＞70歲的老年患者33例，根據是否髮生VAP分為VAP組及非VAP組，對兩組患者的臨床資料進行分析，篩選術後VAP的危險因素、緻病菌及相應敏感藥物。結果33例患者中共16例患者髮生VAP。單因素分析顯示，兩組之間急性生理與慢性健康評分Ⅱ（APACHE Ⅱ）、主動脈阻斷時間、體外循環時間、機械通氣時間及ICU住院時間差異有統計學意義（P＜0.01）。多因素迴歸分析顯示，主動脈阻斷時間及機械通氣時間與VAP髮生明顯相關。分離病原菌19株，多以革蘭陰性桿菌為主（84.2%），其中肺炎剋雷伯菌及銅綠假單胞菌是主要緻病菌，革蘭暘性毬菌及真菌髮生率較低，萬古黴素對革蘭暘性毬菌抗菌活性為100%。結論老年患者心髒術後VAP的髮生與多種因素有關，需提高手術技術縮短主動脈阻斷時間，儘早拔管，閤理使用抗菌藥物，以改善老年患者心髒術後VAP預後。
목적：탐토＞70세노년환자심장수술후호흡궤상관성폐염（VAP）적발병풍험급상관병원학특점，이지도림상합리사용항균약물。방법회고성지분석2013년1월지2014년6월남경의과대학부속남경의원심장외과중증감호병방（ICU）수치적궤계통기시간＞48h차년령＞70세적노년환자33례，근거시부발생VAP분위VAP조급비VAP조，대량조환자적림상자료진행분석，사선술후VAP적위험인소、치병균급상응민감약물。결과33례환자중공16례환자발생VAP。단인소분석현시，량조지간급성생리여만성건강평분Ⅱ（APACHE Ⅱ）、주동맥조단시간、체외순배시간、궤계통기시간급ICU주원시간차이유통계학의의（P＜0.01）。다인소회귀분석현시，주동맥조단시간급궤계통기시간여VAP발생명현상관。분리병원균19주，다이혁란음성간균위주（84.2%），기중폐염극뢰백균급동록가단포균시주요치병균，혁란양성구균급진균발생솔교저，만고매소대혁란양성구균항균활성위100%。결론노년환자심장술후VAP적발생여다충인소유관，수제고수술기술축단주동맥조단시간，진조발관，합리사용항균약물，이개선노년환자심장술후VAP예후。
Objective To explore the risk factors for ventilator-associated pneumonia (VAP) in the patients over 70 years old after heart surgery and investigate the characteristics of the related etiology so as to guide clinical rational use of antimicrobial agents. Methods Clinical data of 33 elderly patients (over 70 years old) with the duration of mechanical ventilation more than 48h after cardiac surgery in our ICU from January 2013 to June 2014 were collected and retrospectively analyzed. The cohort was assigned into VAP and non-AVP groups, and their clinical data were compared and analyzed to screen the risk factors of postoperative VAP, pathogenic bacteria and their sensitive drugs. Results In the 33 patients, there were 16 patients having VAP. Univariate analysis showed that significant differences were seen in the scores of Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ), aorta blocking time, extracorporeal circulation time, mechanical ventilation time and length of ICU hospitalization between the VAP and non-VAP groups (P<0.01). Multivariate analysis indicated that aorta blocking time and duration of mechanical ventilation were significantly associated with VAP. Among the 19 isolated strains of pathogenic bacteria, most of them were Gram-negative bacilli (84.2%). Klebsiella pneumoniae and Pseudomonas aeruginosa were the most common ones. The incidences of Gram-positive cocci and fungi were quite low. The antibacterial activity of vancomycin was 100% to Gram-positive cocci. Conclusion A variety of risk factors are related to postoperative VAP in the elderly patients after cardiac surgery. We clinicians should improve surgical skills to shorten the duration of mechanical ventilation and aortic cross-clamping time and use antimicrobial agents rationally so as to improve the prognosis of VAP in the elderly after cardiac surgery.
