人工瓣膜置换术后感染的危险因素分析及预防策略

董柱; 曹一秋; 张本; 林钊明; 刘莹; 杨博; 马涛; 张卫达; 王晓武

doi:10.13201/j.issn.1001-1439.2019.04.003

人工瓣膜置换术后感染的危险因素分析及预防策略

- 1. 中国人民解放军南部战区总医院心脏外科中心(广州, 510010);
- 2. 南方医科大学;
- 3. 海南省人民医院心外科
基金项目:
国家自然科学基金项目（No：81671885）；广州市科技计划项目（No：201707010066）；广州市珠江科技新星专项（No：201610010094）

详细信息

通讯作者: 王晓武,E-mail:xzwk_wxw@hotmail.com

中图分类号: R541.6

收稿日期: 2018-12-03

Analysis of risk factors for infection and prevention strategy after heart valve replacement

- 1. Department of Cardiac Surgery, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, 510010, China;
- 2. Graduate School, Southern Medical University;
- 3. Department of Cardiac Surgery, Hainan General Hospital

More Information

Corresponding author: WANG Xiaowu, E-mail: xzwk_wxw@hotmail.com

Received Date: 03 December 2018

摘要

摘要: 目的：回顾性总结444例瓣膜置换围术期治疗效果，分析术后感染发病率、种类及相关影响因素，探究心脏瓣膜置换术后感染的主要危险因素及预防策略。方法：回顾性分析本中心2013-07-2018-07行心脏瓣膜置换术的患者444例，其中男209例，女235例，年龄（49.62±12.92）岁；根据围术期感染标准将术后患者分为感染组（71例），非感染组（373例），总结围手术期的各项数据及资料，采用单因素分析得出危险因素并纳入多因素Logistic回归以明确独立危险因素。结果：围术期死亡7例（1.6%），其中感染组死亡5例（7.0%），非感染组死亡2例（0.5%），两组病死率差异有统计学意义（P<0.001）。死亡原因包括低心排综合征5例，多器官功能衰竭2例。围术期感染71例，感染率15.9%，包括肺部感染61例（85.9%），肠道感染3例（4.2%），泌尿系感染2例（2.8%），心内膜感染5例（7.1%）；感染组与非感染组单因素分析提示老年、男性、肥胖、糖尿病、吸烟、血脂异常、术前感染病史、术前肝肾功能异常、术前心功能、病程时限、手术时间、体外循环时间、升主动脉阻断时间、术中出血量、气管插管时间与瓣膜置换术后感染有关，而经Logistic回归分析进一步明确肥胖（OR：5.777；P<0.05）、糖尿病（OR：7.071；P<0.05）、术前感染病史（OR：29.953；P<0.01）、术前肝功能异常（OR：20.546；P<0.01）、病程>10年（OR：5.091；P<0.01）、手术时间（OR：1.969；P<0.01）、升主动脉阻断时间（OR：1.070；P<0.05）、气管插管时间（OR：3.989；P<0.01）为瓣膜置换术后感染的独立危险因素。ROC曲线分析得出，气管插管时间预测瓣膜置换术后感染的效能最高。结论：明确肥胖、糖尿病、术前感染病史、术前肝功能异常、病程>10年、手术时间、升主动脉阻断时间、气管插管时间是术后感染危险因素；围手术期对患者实施综合评估和干预措施，可降低瓣膜置换术后感染风险、提高早期生存率。
- 瓣膜置换术 /
- 感染 /
- 危险因素
Abstract: Objective: To retrospectively analyzed the infection rate, infection type and other related influencing factors of 444 cases of valvular replacement surgery, and identify the risk factors for infection after valve replacement surgery.Method: A total of 444 patients (209 males and 235 females, at a mean age of (49.62±12.92) years with valve replacement surgery at the cardiovascular surgery department of Guangzhou General Hospital of Guangzhou Military Command from July 2013 to July 2018, were collected and retrospectively analyzed.The 71patients infecting after receive valve replacement surgery were assigned into the infection group, and the other patients (n=373) were included in the non-infection group.Risk factors were identified by univariate analysis and further confirmed by Logistic regression.Result: Our study had 7 patients died in perioperative period (1.6%).Infection group had 5 cases (7.0%), non-infection group had 2 cases (0.5%), and the mortality of the two groups was statistically significant (P<0.001).The causes of death include:5 cases withlow cardiac output syndrome (LCOS) and 2 cases with multiple organ dysfunction(MODS).There were 71 patient infected (15.9%) during the perioperative period.Among them, 61 patients were pulmonary infection (85.9%), 3 cases were intestinal infection (4.2%), 2 cases were urinary tract infection (2.8%), and 5 cases were endocardial infection (7.1%).Univariate analysis identified old age, male, obesity, diabetes, smoking, hyperlipidemia, preoperative infection, abnormal liver and kidney function, cardiac function, course of the disease, total operation time, extracorporeal circulation time, aorta blocking time correlation, intubation time were risk factors for infection after valve replacement surgery.Logistic regression analysis further identified obesity (OR:5.777;P<0.05), diabetes (OR:7.071;P<0.05), Preoperative infection (OR:29.953;P<0.01), Abnormal liver function (OR:20.546;P<0.01), Course of the disease>10 year (OR:5.091;P<0.01), total operation time (OR:1.969;P<0.01), aorta blocking time correlation (OR:1.070;P<0.05), Intubation time were (OR:3.989;P<0.01) as independent risk factors for infection after valve replacement surgery.The predictive values of identified risk factors were evaluated based on the area under the receiver operating characteristic (ROC) curve.Conclusion: Perioperative infection is a common complication after valve replacement, and severe infection seriously affects the prognosis of patients.According to independent risk factors, Comprehensive evaluation and intervention during perioperative period can efficiency reduce the risk of infection.
- valve replacement surgery /
- infection /
- risk factors

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