中国医药
中國醫藥
중국의약
China Medicine
2015年
9期
1286-1288
,共3页
急性主动脉夹层%鼻饲%肺炎
急性主動脈夾層%鼻飼%肺炎
급성주동맥협층%비사%폐염
Acute aortic dissection%Tube-fed%Pneumonia
目的 分析急性主动脉夹层术后鼻饲患者肺部感染的特点及危险因素.方法 回顾性分析首都医科大学附属北京安贞医院2010年2月至2013年5月因急性主动脉夹层行急诊手术后鼻饲的72例患者的临床和细菌学资料,根据患者是否发生肺部感染分为感染组(29例)和非感染组(43例).记录术后血乳酸水平、术后并发症发生情况以及重症监护病房(ICU)停留时间、气管插管时间、住院时间、医院死亡情况.结果 急诊主动脉夹层手术后鼻饲患者中肺部感染29例,感染率为40.3％(29/72);感染组病死率27.6％ (8/29),非感染组病死率9.3％ (4/43),差异有统计学意义(P＜0.01);感染组分离出病原菌62株,其中革兰阴性菌40株(64.5％)、革兰阳性菌14株(22.6％)、真菌8株(12.9％);感染组ICU停留时间、气管插管时间、住院时间明显比非感染组延长[(12±7)d比(6±2)d,(8±6)d比(5±1)d,(35±10)d比(20±8)d](P ＜0.01),术后动脉血乳酸水平和气管切开率增高[(7.5±4.2)mmol/L比(5.4±3.6)mmol/L,48.3％(14/29)比11.6％ (5/43)] (P ＜0.05).术后并发症发生率2组间差异无统计学意义(P＞0.05).多元回归分析显示,术后动脉血乳酸水平增高和气管切开是导致鼻饲患者肺部感染的独立危险因素(P＜0.05).结论 急性主动脉夹层术后鼻饲合并肺部感染的患者医院病死率明显增高,术后动脉血乳酸水平增高和气管切开的鼻饲患者肺部感染的危险性增加,革兰阴性杆菌是主要病原菌.
目的 分析急性主動脈夾層術後鼻飼患者肺部感染的特點及危險因素.方法 迴顧性分析首都醫科大學附屬北京安貞醫院2010年2月至2013年5月因急性主動脈夾層行急診手術後鼻飼的72例患者的臨床和細菌學資料,根據患者是否髮生肺部感染分為感染組(29例)和非感染組(43例).記錄術後血乳痠水平、術後併髮癥髮生情況以及重癥鑑護病房(ICU)停留時間、氣管插管時間、住院時間、醫院死亡情況.結果 急診主動脈夾層手術後鼻飼患者中肺部感染29例,感染率為40.3％(29/72);感染組病死率27.6％ (8/29),非感染組病死率9.3％ (4/43),差異有統計學意義(P＜0.01);感染組分離齣病原菌62株,其中革蘭陰性菌40株(64.5％)、革蘭暘性菌14株(22.6％)、真菌8株(12.9％);感染組ICU停留時間、氣管插管時間、住院時間明顯比非感染組延長[(12±7)d比(6±2)d,(8±6)d比(5±1)d,(35±10)d比(20±8)d](P ＜0.01),術後動脈血乳痠水平和氣管切開率增高[(7.5±4.2)mmol/L比(5.4±3.6)mmol/L,48.3％(14/29)比11.6％ (5/43)] (P ＜0.05).術後併髮癥髮生率2組間差異無統計學意義(P＞0.05).多元迴歸分析顯示,術後動脈血乳痠水平增高和氣管切開是導緻鼻飼患者肺部感染的獨立危險因素(P＜0.05).結論 急性主動脈夾層術後鼻飼閤併肺部感染的患者醫院病死率明顯增高,術後動脈血乳痠水平增高和氣管切開的鼻飼患者肺部感染的危險性增加,革蘭陰性桿菌是主要病原菌.
목적 분석급성주동맥협층술후비사환자폐부감염적특점급위험인소.방법 회고성분석수도의과대학부속북경안정의원2010년2월지2013년5월인급성주동맥협층행급진수술후비사적72례환자적림상화세균학자료,근거환자시부발생폐부감염분위감염조(29례)화비감염조(43례).기록술후혈유산수평、술후병발증발생정황이급중증감호병방(ICU)정류시간、기관삽관시간、주원시간、의원사망정황.결과 급진주동맥협층수술후비사환자중폐부감염29례,감염솔위40.3％(29/72);감염조병사솔27.6％ (8/29),비감염조병사솔9.3％ (4/43),차이유통계학의의(P＜0.01);감염조분리출병원균62주,기중혁란음성균40주(64.5％)、혁란양성균14주(22.6％)、진균8주(12.9％);감염조ICU정류시간、기관삽관시간、주원시간명현비비감염조연장[(12±7)d비(6±2)d,(8±6)d비(5±1)d,(35±10)d비(20±8)d](P ＜0.01),술후동맥혈유산수평화기관절개솔증고[(7.5±4.2)mmol/L비(5.4±3.6)mmol/L,48.3％(14/29)비11.6％ (5/43)] (P ＜0.05).술후병발증발생솔2조간차이무통계학의의(P＞0.05).다원회귀분석현시,술후동맥혈유산수평증고화기관절개시도치비사환자폐부감염적독립위험인소(P＜0.05).결론 급성주동맥협층술후비사합병폐부감염적환자의원병사솔명현증고,술후동맥혈유산수평증고화기관절개적비사환자폐부감염적위험성증가,혁란음성간균시주요병원균.
Objective To explore the characteristics and risk factors of pulmonary infection in patients with nasal feeding after acute aortic dissection operation.Methods Clinical and bacteriology data of 72 patients with nasal feeding after acute aortic dissection operation from February 2010 to May 2013 were retrospectively analyzed.The patients were divided into pulmonary infection group and non-pulmonary infection group.The postoperative lactic acid level,postoperative complications,intensive care unit (ICU) time,length of trachea intubation time,length of hospital stay and death were recorded and compared between the two groups.Results The incidence of pulmonary infection was 40.3％ (29/72).The mortality of pulmonary infection group was significantly higher than that of non-pulmonary infection group [27.6％ (8/29) vs 9.3％ (4/43)] (P ＜ 0.01).Totally 62 strains were separated,including 40 strains of gram-negative bacilli (64.5％),14 strains of gram-positive (22.6％) and 8 strains of fungus (12.9％).The ICU time,length of trachea intubation time and length of hospital stay were significantly longer,meanwhile the postoperative lactic acid level and incidence of tracheotomy were significantly higher in pulmonary infection group compared with those in non-pulmonary infection group [(12-± 7) d vs (6±2) d,(8±6) d vs (5 ±1) d,(35 ±20) d vs (20 ±8) d 6,(7.5 ±4.2) mmol/L vs (5.4 ± 3.6) mmol/L,48.3％ (14/29) vs 11.6％ (5/43)] (P ＜ 0.01 or P ＜ 0.05).Logistic regression analysis showed that the increased lactic acid level and tracheostomy after operation were independent risk factors of pulmonary infection (P ＜0.05).Conclusion The hospital mortality is significantly increased in nasal feeding patients complicated with pneumonia after acute aortic dissection operation ; the increased blood lactic acid level and tracheostomy are independent risk factors of pneumonia; the gram-negative bacilli are main pathogens.
