中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

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儿童法洛四联症术后呼吸机相关性肺炎的临床研究

曾晓东 , 陈寄梅 , 庄建 , 朱卫中 , 罗丹东 , 雷黎明 , 葛同开

广东省心血管病研究所 广东省人民医院 广东省医学科学院 心外科（广州  510080）

收稿日期: 2018-10-21;  修回日期:2018-11-23; 

基金项目: 国家重点研发计划（2018YFC1002600）

通讯作者: 陈寄梅, Email: jimei1965@gmail.com

Clinical study of ventilator-associated pneumonia in children after surgical correction for Tetralogy of Fallot

ZENG Xiaodong , CHEN Jimei , ZHUANG Jian , ZHU Weizhong , LUO Dandong , LEI Liming , GE Tongkai

Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academic of Medical Science, Guangzhou 510080, P.R.China

Corresponding Author: CHEN Jimei, Email: jimei1965@gmail.com

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目的 探讨法洛四联症（Tetralogy of Fallot, TOF）术后呼吸机相关性肺炎（Ventilator-associated pneumonia, VAP）的发生率、病原菌特点、危险因素及预后情况，为 TOF 术后 VAP 防治提供可靠临床依据。 方法 将 2013 年 1 月至 2017 年 12 月在广东省人民医院心外科行 TOF 术后机械通气超过 48 小时的 181 例患儿，男 121 例，女 60 例，平均年龄（11.2±10.4）月，分为 VAP 组（n=44）和非 VAP 组（n=137），用 t 检验、χ2 检验及 logistic 回归分析方法，筛选 VAP 发病的可能危险因素。 结果 共纳入 181 例，其中 VAP 44 例，非 VAP 137 例，VAP 发生率为 24.3%。 VAP 常见病原菌为革兰阴性菌占 69.7%。单因素分析发现两组在术前缺氧发作、术前肺炎、术前使用呼吸机、体外循环（CPB）时间、气管插管重插管、肺不张、低心排、腹腔引流、输注新鲜冰冻血浆等方面比较，差异有统计学意义（P<0.05）；多因素 logistic 回归分析显示：体外循环时间（OR 值 1.011）、气管插管重插管（OR 值 14.548）、肺不张（OR 值 6.139）、低心排（OR 值 3.054）为法洛四联症术后 VAP 发生的独立危险因素（P<0.05）。与非 VAP 组相比，VAP 患儿机械通气时间长、ICU 停留时间长，总住院时间长。 结论 TOF 术后 VAP 发生率较高，致使病人机械通气时间及住院时间延长，应根据 VAP 的危险因素采取综合防治措施，以期降低其发生率。

Objectives This study aimed to investigate the incidence, pathogens, risk factors and clinical outcomes for ventilator- associated pneumonia (VAP) in children after tetralogy of Fallot (TOF) surgical correction, in order to offer reliable data for the prevention of VAP. Methods This was a retrospective study performed at Guangdong General Hospital and 181 children (male 121, female 60, mean age 11.2±10.4 months) undergoing surgical correction for TOF were included. ALL the children who received mechanical ventilation for 48 hours or longer between January 2013 and December 2017 were classified into VAP group (n=44) and non-VAP group (n=137). T test, χ2 test and multiple logistic regression analysis were used to identify the possible risk factors for VAP. Results This study enrolled 181 patients , of which 44 were diagnosed as having VAP, and the incidence of VAP was 24.3%. The most frequent isolated pathogen was Gram-Negative bacteria (69.7%). Single factor analysis showed that the variables significantly associated with a risk factor of VAP were: hypoxic spells, preoperative pneumonia, preoperative mechanical ventilation support, cardiopulmonary bypass time (CPB), reintubation, pulmonary atelectasis, low cardiac output syndrome (LCOS), intra-abdominal drainage and transfusion of fresh frozen plasma. The multiple logistic regression showed CPB time (OR=1.011), reintubation (OR=14.548), pulmonary atelectasis (OR=6.139) and LCOS (OR=3.054) were independent risk factors for VAP in children after TOF surgical correction. Patients with VAP had prolonged duration of mechanical ventilation, a longer ICU stay and longer hospitalization time. Conclusions The VAP rate in this population is higher than that reported abroad, which leads to prolonged duration of mechanical ventilation and a longer hospital stay. The effective measures for prevention of VAP should be taken according to the related risk factors for VAP to decrease the incidence of VAP in children after TOF surgical correction.

关键词: 法洛四联症; 呼吸机相关性肺炎; 发生率; 病原菌; 危险因素; 预后

Key words: Tetralogy of Fallot; Ventilator-associated pneumonia; Incidence; Pathogen; Risk factor; Outcome

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