体外循环心脏术后肺部感染的危险因素及其预测模型
Risk factors for postoperative pulmonary infections after cardiopulmonary bypass and their prediction model
彭婷婷 1邓殉 1张山2
作者信息
- 1. 首都医科大学附属北京安贞医院心脏外科危重症中心,北京 100029
- 2. 首都医科大学附属北京安贞医院心脏外科危重症中心,北京 100029;首都医科大学护理学院,北京 100069
- 折叠
摘要
目的 分析体外循环心脏术后肺部感染的危险因素及其预警模型.方法 选择2021年1月-2022年12月于某三甲医院ICU完成体外循环心脏手术的172例患者展开回顾性分析,依据患者术后肺部感染情况分为感染组(n=41)和对照组(n=131);采用多因素Logistic回归分析归纳体外循环心脏术后肺部感染的危险因素,构建多因素联合应用的预警模型,总结感染组患者病原菌情况.结果 糖尿病、体外循环时间、美国麻醉师协会(ASA)分级为体外循环心脏术后患者发生肺部感染的危险因素,淋巴细胞(LYM)是保护因素(P＜0.05);由危险因素构建的Log(P)预警模型,对体外循环心脏术后患者发生肺部感染的预警效能较高,受试者工作特征曲线下面积(ROC-AUC)(0.95CI)为0.884(0.769～0.969);感染组患者的病原菌以革兰阴性菌(70.59％)为主,其中鲍氏不动杆菌(36.76％)为主要菌株.结论 糖尿病、体外循环时间、ASA分级Ⅲ～Ⅳ级是体外循环心脏术后肺部感染的危险因素,LYM为保护因素,临床应对高危患者加强监测和预警,并及时依据感染菌株给予抗菌药物治疗,以改善患者预后.
Abstract
OBJECTIVE To analyze the risk factors for postoperative pulmonary infections after cardiopulmonary bypass and their early warning model.METHODS Retrospective analysis was performed on 172 patients who com-pleted cardiac surgery with extracorporeal circulation in the ICU of a tertiary hospital from Jan.2021 to Dec.2022,and the patients were divided into an infection group(n=41)and a control group(n=131)according to postoper-ative pulmonary infection.Multivariate logistic regression was used to analyze and summarize the risk factors for postoperative pulmonary infection after cardiopulmonary bypass(CPB),to construct a multi-factor early warning model that applied in a combined manner,and to summarize the pathogenic bacteria of patients in the infected group.RESULTS Diabetes mellitus,duration of cardiopulmonary bypass,and American society of Anesthesiolo-gists(ASA)classification were risk factors for the occurrence of pulmonary infections in patients after cardiopul-monary bypass,and lymphocyte(LYM)was a protective factor(P＜0.05).The Log(P)early warning model constructed from risk factors had a high efficacy of early warning for the occurrence of pulmonary infections in pa-tients after cardiopulmonary bypass(CPB),and the area under the network subject operating characteristic curve(ROC-AUC)(0.95CI)was 0.884(0.769-0.969).In the infection group,gram-negative bacteria(70.59％)were the main pathogenic bacteria,and with Acinetobacter baumannrii(36.76％)as the main strain.CONCLUSION Diabetes mellitus,duration of cardiopulmonary bypass,and ASA grade Ⅲ-Ⅳ were risk factors for pulmonary infection after cardiopulmonary bypass,and LYM was a protective factor.Clinical monitoring and early warning should be strengthened for high-risk patients,and antibiotics should be given according to the strains of infection in time to improve the prognosis of patients.
关键词
心脏手术/体外循环/肺部感染/预测模型/病原学/危险因素Key words
Cardiac surgery/Extracorporeal circulation/Pulmonary infection/Prediction model/Etiology/Risk factor引用本文复制引用
基金项目
北京市教育委员会科研计划基金资助项目(KM202310025016)
首都医科大学引进人才基金资助项目(1220012903)
出版年
2024
NETL
NSTL
万方数据