|
| CPB下行心内直视手术患者术后肺部感染的易感因素分析 |
| Analysis of Susceptible Factors for Postoperative Pulmonary Infection in Patients Undergoing Open-Heart Surgery with CPB |
| 投稿时间：2025-07-16 |
| DOI：10.3969/j.issn.1000-0399.2026.07.015 |
| 中文关键词: 体外循环 心内直视手术 肺部感染 危险因素 |
| 英文关键词: Cardiopulmonary bypass Open-heart surgery Pulmonary infection Risk factors |
| 基金项目:空军军医大学第一附属医院2024年度学科助推计划重点项目(编号:2024XJSZ03) |
|
| 摘要点击次数: 215 |
| 全文下载次数: 0 |
| 中文摘要: |
| 目的 探讨体外循环（CPB）下行心内直视手术患者术后肺部感染的易感因素分析。方法 回顾性选取空军军医大学第一附属医院心血管外科2023年1月至2025年3月69例CPB下行心内直视手术后发生肺部感染患者为感染组，同时以1∶1比例随机选取同期医院69例CPB下行心内直视手术后未发生任何肺部感染患者为未感染组，记录所有患者临床资料，采用logistic回归模型分析CPB下行心内直视手术患者术后肺部感染相关危险因素，采用受试者工作特征（ROC）曲线评估预测指标对术后肺部感染易感因素的预测价值，并根据危险因素构建决策树模型。结果 69例CPB下行心内直视手术后肺部感染患者，共培养分离病原菌114株，其中以革兰阴性菌为主；多因素分析结果显示：CPB时间（OR=6.291,95%CI:1.178～33.585,P=0.031）、机械通气时间（OR=1.076,95%CI:1.046～1.107,P<0.001）、术前心功能分级（OR=4.615,95%CI:1.341～15.889,P=0.015）、术前ASA分级（OR=5.386,95%CI:1.427～20.338,P=0.013）是CPB下行心内直视手术患者术后肺部感染的独立危险因素（均P<0.05）;ROC曲线分析显示：CPB时间、机械通气时间、术前心功能分级、术前ASA分级及联合预测对CPB下行心内直视手术患者术后肺部感染均具有统计学意义（P<0.05），其中联合检测的诊断效能：曲线下面积（AUC）=0.942,95%CI:0.903～0.980，灵敏度为81.2%，特异度为95.7%；决策树模型显示，位于第1层的机械通气时间是最重要的预测因子，模型的分类准确率为87.70%。结论 CPB时间、机械通气时间、术前心功能分级、术前ASA分级是CPB下行心内直视手术后发生肺部感染的独立危险因素，均具有一定诊断价值且联合预测价值较高。 |
| 英文摘要: |
| Objective To investigate the susceptibility factors for postoperative pulmonary infections in patients undergoing direct cardiac surgery under cardiopulmonary bypass(CPB). Methods A retrospective selection was made of 69 patients with pulmonary infection after open heart surgery under CPB in the Department of Cardiovascular Surgery of the First Affiliated Hospital of Air Force Military Medical University from January 2023 to March 2025 as the infection group(n=69). Meanwhile, 69 patients who did not have any pulmonary infections after CPB-undergoing endocardial direct vision surgery in the same period of time in the same hospital were randomly selected in a ratio of 1:1 and set up as the uninfected group(n=69), and the clinical data of all the patients were recorded, and a logistic regression model was used to analyse the risk factors related to postoperative lung infection in patients undergoing endocardial rectal surgery under CPB. ROC curve was plotted to assess the predictive value of predictive indexes on susceptibility factors for postoperative lung infection, and a decision tree model was constructed based on the risk factors. Results A total of 114 pathogenic bacteria were isolated by culture from 69 patients with lung infections after direct intracardiac surgery under CPB, with a predominance of gram-negative bacteria. The multifactorial results showed that CPB time(OR=6.291, 95%CI:1.178～33.585,P=0.031), mechanical ventilation time(OR=1.076, 95%CI:1.046～1.107,P<0.001) preoperative cardiac function classification(OR=4.615, 95%CI:1.341～15.889,P=0.015), and preoperative ASA classification(OR=5.386, 95%CI:1.427～20.338,P=0.013) were the independent risk factors for postoperative lung infection in patients who underwent endomyocardial rectal vision surgery under CPB(P<0.05). The ROC analyses showed that CPB time, mechanical ventilation time, preoperative cardiac function grading, preoperative ASA grading and combined prediction were statistically significant for postoperative lung infection in patients undergoing direct endocardial surgery under CPB(P< 0.05), with the diagnostic efficacy analysis of the combined test: AUC = 0.942, 95% CI:0.903～0.980, sensitivity of 0.812, and specificity of 0.957. The decision tree model showed that the duration of mechanical ventilation, located in stratum 1, was the most important predictor, and the classification accuracy of the model was 87.70%. Conclusion CPB time, mechanical ventilation time, preoperative cardiac function grading, preoperative ASA grading are independent risk factors for pulmonary infection after endocardial direct vision surgery under CPB, all of which have a certain diagnostic value, and the joint predictive value is higher. Clinical medical personnel need to pay attention to the patients with the above influencing factors so as to prevent postoperative pulmonary infections。 |
|
查看全文
查看/发表评论 下载PDF阅读器 |
| 关闭 |
|
|
|
