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中华肺部疾病杂志(电子版)

中华肺部疾病杂志(电子版) ›› 2023, Vol. 16 ›› Issue (02) : 175 -179. doi: 10.3877/cma.j.issn.1674-6902.2023.02.005

论著

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
叶晓芳1, 杨京华1, 武元星1, 朱光发1,†()   
  1. 1. 100029　北京，首都医科大学附属北京安贞医院呼吸与危重症医学科
  • 收稿日期:2023-01-11 出版日期:2023-04-25
  • 通信作者: 朱光发

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

Xiaofang Ye1, Jinghua Yang1, Yuanxing Wu1, Guangfa Zhu1,†()   

  1. 1. Department of Respiratory and Critical Care Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute Heart, Lung and Blood Vessel Diseases, Beijing 100029, China
  • Received:2023-01-11 Published:2023-04-25
  • Corresponding author: Guangfa Zhu
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引用本文：

叶晓芳, 杨京华, 武元星, 朱光发. 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[J]. 中华肺部疾病杂志(电子版), 2023, 16(02): 175-179.

Xiaofang Ye, Jinghua Yang, Yuanxing Wu, Guangfa Zhu. Prognostic influence and risk factors of pneumonia after coronary artery bypass transplantation in patients with COPD[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2023, 16(02): 175-179.

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 0.012a
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 0.016a
FEV1≤60% 32(42.67) 36(25.17) 7.013 0.008a
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 0.014a
LVEF<50%[n(%)] 28(37.33) 51(35.66) 0.059 0.808
OPCABG[n(%)] 44(58.67) 110(76.92) 7.906 0.005a
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) 0.002a
FEV1% －0.640 0.032 4.077 0.939(0.881~0.998) 0.043a
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