2020 年第 1 期 第 15 卷

心脏移植受者术后首次住院期间获得性肺部感染和肺部感染死亡的危险因素分析

Risk factors of acquired pulmonary infection and death during the first hospitalization after heart transplantation

作者：袁婷邱贝丽李燕君曾珠徐芬

英文作者：

单位：华中科技大学同济医学院附属协和医院心脏大血管外科,武汉430000

英文单位：

关键词：心脏移植；肺部感染；危险因素；呼吸机相关性肺炎

英文关键词：

• 摘要：

• 【摘要】目的    分析心脏移植受者术后首次住院期间获得性肺部感染和肺部感染死亡的危险因素。方法    回顾性分析2013年4月至2018年1月华中科技大学同济医学院附属协和医院收治的520例心脏移植受者的病历资料，记录其中发生医院获得性肺部感染的临床特征，然后采用单因素和多因素Logistic回归方法分析相关危险因素。结果    术后首次住院期间发生肺部感染66例（肺部感染组），非肺部感染组454例。单因素分析结果显示肺部感染组心脏移植受者术后24～48 h急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分＞6分、术后气管插管时间＞24 h、术后再次插管、术后留置胃管＞24 h以及术后发生中枢神经系统并发症的比例高于非肺部感染组［90.9%（60/66）比53.1%（241/454）、77.3%（51/66）比33.9%（154/454）、22.7%（15/66）比5.9%（27/454）、40.9%（27/66）比18.1%（82/454）、18.2%（12/66）比4.0%（18/454）］，差异均有统计学意义（均P＜0.05）。Logistic回归分析结果显示术后24～48 h APACHEⅡ评分＞6分和术后气管插管时间＞24 h为心脏移植受者术后医院获得性肺部感染发生的独立危险因素（均P<0.05）。以死亡为因变量，以呼吸机相关性肺炎（VAP）、真菌感染、致病菌种数以及临床肺部感染评分作为自变量进行单因素和多因素分析，结果显示VAP和致病菌种数为心脏移植受者术后肺部感染死亡的独立危险因素（均P<0.05）。结论    术后24～48 h APACHEⅡ评分＞6分和术后气管插管时间＞24 h是首次住院期间医院获得性肺部感染的独立危险因素，VAP和致病菌种数是肺部感染死亡的危险因素，积极预防VAP对降低死亡率、改善预后具有十分重要的作用。

• 【Abstract】Objective    To analyze the risk factors of acquired pulmonary infection and death during the first hospitalization after heart transplantation. Methods    A retrospective analysis was made on 520 patients who had heart transplantation in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from April 2013 to January 2018. General data and clinical characteristics of hospital-acquired pulmonary infection were recorded. Risk factors of pulmonary infection and death were analyzed by single-factor and multi-factor logistic regression. Results    Among 520 patients, hospital-acquired pulmonary infection occurred in 66 cases (pulmonary infection group) and 454 patients were induded in non-infection group. Single-factor analysis showed that pulmonary infection group had higher rates of Acute Physiology and Chronic Health Evaluation Ⅱ(APACHEⅡ) score>6 in 24-48 h after surgery, tracheal intubation>24 h, re-intubation, indwelling gastric tube>24 h and postoperative central nervous system complications, as compared with non-infection group［90.9%（60/66） vs 53.1%（241/454）, 77.3%（51/66） vs 33.9%（154/454）, 22.7%（15/66） vs 5.9%（27/454）, 40.9%（27/66） vs 18.1%（82/454）, 18.2%（12/66） vs 4.0%（18/454）］（all P＜0.05）. Logistic regression analysis showed that APACHE Ⅱ score>6 in 24-48 h after surgery and tracheal intubation>24 h were independent risk factors of hospital-acquired pulmonary infection(both P<0.05). Ventilator-associated pneumonia(VAP), fungal infection, the number of pathogenic bacteria species and clinical lung infection score were involved in the analysis of death factors, showing that VAP and the number of pathogenic bacteria species were independent risk factors of death due to pulmonary infection(both P<0.05). Conclusions    APACHEⅡ score>6 in 24-48 h after heart transplantation and tracheal intubation>24 h are independent risk factors of hospital-acquired pulmonary infection. VAP and the number of pathogen species are risk factors of death caused by pulmonary infection. Effective intervention measures to prevent VAP is important in reducing mortality and improving prognosis.