心脏瓣膜置换术患者肺部感染相关因素分析与预防

发布时间：2018-07-17 09:14

【摘要】：目的探究诱发心脏瓣膜置换术患者肺部感染相关因素,并提出相应预防措施。方法随机选取2014年8月-2016年8月医院收治的接受心脏瓣膜置换术治疗的60例心脏瓣膜疾病患者,观察患者手术治疗后肺部感染情况,分析感染的诱发因素,并制定有效的预防措施。结果经心脏瓣膜置换术治疗后患者的中心静脉压(CVP)、心脏指数(CI)、全心舒张末期容积指数(GEDI)[(9.68±0.98)mmHg、5.98±0.43、887.89±31.87]等血流动力学指标明显优于治疗前[(13.78±1.57)mmHg、4.19±0.34、768.86±28.86],差异有统计学意义(P0.05);60例患者中,术后20例患者发生肺部感染,感染率为33.33%,感染患者共分离出病原菌20株,其中,革兰阴性菌14株占70.00%,革兰阳性菌5株占25.00%,真菌1株占5.00%;感染组患者左心室射血分数(LVEF)、气管插管拔管时间及呼吸机使用时间[(44.23±12.12)%、(29.39±7.01)h、(16.97±5.46)h]与非感染组患者[(56.10±13.23)%、(24.13±6.44)h、(11.29±4.53)h]相比差异有统计学意义(P0.05);感染组患者胸骨哆开、再次开胸止血、低心排综合征发生率与非感染组患者相比明显增高,差异有统计学意义(P0.05)。结论诱发心脏瓣膜置换术后肺部感染因素主要有LVEF、呼吸机使用时间、气管拔管时间、再次开胸止血、胸骨哆开、低心排综合征等;采取针对性措施,可降低肺部感染发生率,提高患者治疗预后。
[Abstract]:Objective to investigate the related factors of pulmonary infection in patients undergoing cardiac valve replacement and to put forward corresponding preventive measures. Methods from August 2014 to August 2016, 60 patients with heart valve disease treated by cardiac valve replacement were randomly selected to observe the pulmonary infection after surgical treatment, and analyze the inducing factors of infection. And make effective preventive measures. Results the hemodynamic indexes such as central venous pressure (CVP), cardiac index (CI), total cardiac end-diastolic volume index (GEDI) [(9.68 卤0.98) mm HgN 5.98 卤0.43887.89 卤31.87] were significantly better than those before the treatment [(13.78 卤1.57) mm Hg 4.19 卤0.34768.86 卤28.86] (P 0.05). Twenty patients developed pulmonary infection after operation, the infection rate was 33.33%. 20 strains of pathogenic bacteria were isolated from the infected patients. There were significant differences in left ventricular ejection fraction (LVEF), tracheal intubation extubation time and ventilator use time (44.23 卤12.12), (29.39 卤7.01) h, (16.97 卤5.46) h between infected group and non-infected group [(56.10 卤13.23) h, (24.13 卤6.44) h, (11.29 卤4.53) h] The sternum in the infected group was doxotomized. The incidence of low cardiac output syndrome was significantly higher than that of non-infection group (P0.05). Conclusion the main causes of pulmonary infection after cardiac valve replacement are LVEF, time of ventilator use, time of tracheal extubation, reopening of chest to stop bleeding, sternum reopening, low cardiac output syndrome and so on. To improve the prognosis of patients.
【作者单位】：海南医学院附属医院心脏外科;
【分类号】：R563.1;R654.2

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