COPD患者冠状动脉旁路移植术后肺部感染的预后影响及危险因素分析

doi:10.3877/cma.j.issn.1674-6902.2023.02.005

目的

分析慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)患者接受冠状动脉旁路移植术(coronary artery bypass grafting, CABG)术后发生肺部感染的危险因素及其对预后的影响。

方法

回顾性分析2021年1月至2021年12月首都医科大学附属北京安贞医院收治的CABG手术的COPD患者临床资料，按照术后住院期间是否发生肺部感染，分为观察组75例及对照组143例，对其术前、术后的临床资料进行分析，以分析肺部感染的预后影响及危险因素。

结果

共纳入218例患者，术后肺部感染的发生率为75例(34.40%)。观察组术后住院时间平均延长1.81 d(P<0.001)；30 d及1年病死率组间无统计学差异。多元二分类Logistic回归分析显示，第一秒用力呼气容积(FEV₁%)与CABG术后肺部感染发生率负相关(OR＝0.938，95%CI: 0.881~0.998，P<0.05)，年龄≥65岁(OR＝4.027，95%CI: 2.101~7.719，P<0.001)、FEV₁≤60%(OR＝9.255，95%CI: 2.328~36.794，P＝0.002)是术后发生肺部感染的危险因素。

结论

CABG术后发生肺部感染会延长住院时间，对30 d及1年病死率无影响。年龄≥65岁、FEV₁≤60%是COPD患者CABG术后发生肺部感染的危险因素。

关键词: 肺部感染, 肺疾病，慢性阻塞性, 冠状动脉旁路移植术, 第一秒用力呼气容积

Objective

To investigate the risk factors of pneumonia after coronary artery bypass grafting (CABG) in patients with chronic obstructive pulmonary disease (COPD) and its influence on prognosis.

Methods

The clinical data of COPD patients undergoing CABG surgery admitted to Beijing Anzhen Hospital Affiliated to Capital Medical University from January 2021 to December 2021 were retrospectively analyzed. According to whether postoperative pneumonia occurred during the postoperative hospitalization, the patients were divided into observation group 75 cases and control group 143 cases. The preoperative and postoperative clinical data were analyzed to explore the risk factors of pneumonia.

Results

A total of 218 patients were included, ranging in age from 45 to 76 years, with an average age of (64.81±7.72) years, including 149 males (68.35%). The incidence of postoperative pulmonary infection was 75 cases(34.40%). The average length of postoperative hospital stay in the observation group was extended by 1.81 days (P<0.001), but there was no significant difference in mortality at 30 days and within 1 year between the two groups. Multivariate binary Logistic regression analysis showed that FEV₁% was negatively correlated with the incidence of postoperative pneumonia of CABG (OR=0.938, 95%CI: 0.881~0.998, P<0.05). Age ≥65 years old (OR=4.027, 95%CI: 2.101~7.719, P<0.001), forced expiratory volume in the first second (FEV₁)≤60% (OR=9.255, 95%CI: 2.328~36.794, P=0.002) were risk factors for postoperative pneumonia.

Conclusions

Pulmonary infection after CABG surgery prolonged hospital stay and had no effect on 30 d and 1-year mortality. Age≥65 years and FEV₁≤60% are risk factors for pulmonary infection after CABG in COPD patients.

Key words: Pulmonary infection, Coronary artery bypass grafting, Chronic obstructive pulmonary disease, Forced expiratory volume in the first second

表1 患者术前基线资料及手术相关情况比较[±s，n(%)]

临床资料	观察组(n＝75)	对照组(n＝143)	t/χ²	P值
年龄≥65岁	49(65.33)	68(47.55)	6.255	0.012^a
BMI(kg/m²)	26.12±6.41	26.41±6.88	0.880	0.290
糖尿病	22(29.33)	50(34.97)	0.705	0.401
高脂血症	69(92.00)	131(91.61)	0.100	0.921
高血压	55(73.33)	106(74.13)	0.160	0.899
脑梗塞	16(21.33)	29(20.28)	0.033	0.855
其他肺部疾病	5(6.67)	9(6.29)	0.014	0.905
PVD	52(69.33)	101(70.63)	0.039	0.842
既往经皮冠状动脉介入	11(14.67)	25(17.48)	0.283	0.595
SinoSCOREⅡ	19.28±4.98	18.84±5.15	0.776	0.352
FEV₁%	64.60±11.86	68.03±8.74	－2.423	0.016^a
FEV₁≤60%	32(42.67)	36(25.17)	7.013	0.008^a
肌酐清除率(ml/min)	67.68±23.30	64.78±21.46	0.919	0.359
PaO₂(mmHg)	85.05±8.70	84.68±8.53	0.306	0.760
PaCO₂(mmHg)	42.15±6.51	41.12±6.25	1.137	0.257
术前NYHA心功能分级Ⅲ~Ⅳ级	43(57.33)	57(39.86)	6.049	0.014^a
LVEF<50%[n(%)]	28(37.33)	51(35.66)	0.059	0.808
OPCABG[n(%)]	44(58.67)	110(76.92)	7.906	0.005^a
旁路移植血管数			5.132	0.162
1支	12	36	5.132	0.162
2支	20	39	5.132	0.162
3支	31	57	5.132	0.162
≥4支	12	11	5.132	0.162

表1 患者术前基线资料及手术相关情况比较[±s，n(%)]

临床资料	观察组(n＝75)	对照组(n＝143)	t/χ²	P值
年龄≥65岁	49(65.33)	68(47.55)	6.255	0.012^a
BMI(kg/m²)	26.12±6.41	26.41±6.88	0.880	0.290
糖尿病	22(29.33)	50(34.97)	0.705	0.401
高脂血症	69(92.00)	131(91.61)	0.100	0.921
高血压	55(73.33)	106(74.13)	0.160	0.899
脑梗塞	16(21.33)	29(20.28)	0.033	0.855
其他肺部疾病	5(6.67)	9(6.29)	0.014	0.905
PVD	52(69.33)	101(70.63)	0.039	0.842
既往经皮冠状动脉介入	11(14.67)	25(17.48)	0.283	0.595
SinoSCOREⅡ	19.28±4.98	18.84±5.15	0.776	0.352
FEV₁%	64.60±11.86	68.03±8.74	－2.423	0.016^a
FEV₁≤60%	32(42.67)	36(25.17)	7.013	0.008^a
肌酐清除率(ml/min)	67.68±23.30	64.78±21.46	0.919	0.359
PaO₂(mmHg)	85.05±8.70	84.68±8.53	0.306	0.760
PaCO₂(mmHg)	42.15±6.51	41.12±6.25	1.137	0.257
术前NYHA心功能分级Ⅲ~Ⅳ级	43(57.33)	57(39.86)	6.049	0.014^a
LVEF<50%[n(%)]	28(37.33)	51(35.66)	0.059	0.808
OPCABG[n(%)]	44(58.67)	110(76.92)	7.906	0.005^a
旁路移植血管数			5.132	0.162
1支	12	36	5.132	0.162
2支	20	39	5.132	0.162
3支	31	57	5.132	0.162
≥4支	12	11	5.132	0.162

表2 COPD患者CABG术后肺部感染的二元Logistic回归分析结果

临床资料	B值	S.E.值	Wald值	OR(95%CI)值	P值
年龄≥65岁	1.393	0.332	17.616	4.027(2.101~7.719)	0.000
NYHA心功能分级Ⅲ~Ⅳ级	0.297	0.335	0.789	0.743(0.366~1.431)	0.374
OPCAB	0.139	0.330	0.178	0.870(0.455~1.661)	0.673
FEV₁%≤60%	2.225	0.704	9.984	9.255(2.328~36.794)	0.002^a
FEV₁%	－0.640	0.032	4.077	0.939(0.881~0.998)	0.043^a

表2 COPD患者CABG术后肺部感染的二元Logistic回归分析结果

临床资料	B值	S.E.值	Wald值	OR(95%CI)值	P值
年龄≥65岁	1.393	0.332	17.616	4.027(2.101~7.719)	0.000
NYHA心功能分级Ⅲ~Ⅳ级	0.297	0.335	0.789	0.743(0.366~1.431)	0.374
OPCAB	0.139	0.330	0.178	0.870(0.455~1.661)	0.673
FEV₁%≤60%	2.225	0.704	9.984	9.255(2.328~36.794)	0.002^a
FEV₁%	－0.640	0.032	4.077	0.939(0.881~0.998)	0.043^a

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Prognostic influence and risk factors of pneumonia after coronary artery bypass transplantation in patients with COPD

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Prognostic influence and risk factors of pneumonia after coronary artery bypass transplantation in patients with COPD