Analysis Of Risk Factors And Etiology Of Pulmonary Infection After Cardiopulmonary Bypass In Adults

Objective:A clinical study on the risk factors,etiological characteristics and drug resistance of pulmonary infection in patients undergoing cardiopulmonary bypass in adult patients in cardiovascular surgery were conducted to explore ways to prevent and reduce pulmonary infection,and to provide a theoretical basis for clinical treatment and prevention.Methods:The clinical data of 417 adult patients undergoing open heart surgery under cardiopulmonary bypass from July 2017 to December 2017 in the Department of Cardiovascular surgery of Union Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology were retrospectively analyzed.According to the diagnostic criteria of pulmonary infection,they were divided into pulmonary infection group and non-pulmonary infection group.The incidence of postoperative pulmonary infection was counted and all possible factors were included in the study.The measurement data were analyzed by two independent samples t-test and the counting data were analyzed by chi-square test or Fisher's exact test for univariate analysis.The independent risk factors of pulmonary infection were analyzed by binary logistic regression analysis for statistically significant variables.Results:?1?Pulmonary infection occurred in 68 patients?16.31%?and the incidence of postoperative pulmonary infection in patients with macrovascular surgery was the highest?37.04%?.Compared with the non-pulmonary infection group,the postoperative ICU retention time and postoperative hospital stay were longer in the pulmonary infection group,and the cure rate was lower?P< 0.05?.?2?The results of binary logistic regression analysis showed that age > 60 years old,preoperative red blood cell count < 4×1012/L,preoperative albumin < 30g/L,cardiopulmonary bypass time>120 minutes,aortic occlusion time>80minutes,postoperative creatinine>110?mol/L,postoperative heart rate>100 beats/min,postoperative Sa O2<95%,postoperative Lactic acid value>4mmol / L,minimum OI<200mm Hg within 12 hours after surgery,red blood cell transfusion within 24 hours after operation > 4U and mechanical ventilation time > 48 h etc,are independent risk factors for pulmonary infection after surgery under cardiopulmonary bypass in adult patient.?3?113 strains of pathogenic bacteria were detected in 68 patients with pulmonary infection,among which Gram-negative bacteria?Gram-negative bacteria?were the dominant one?80 strains,70.79%?.The top six were Acinetobacter baumannii?37.17%?,Candida albicans ?15.93%?,Pseudomonas aeruginosa?11.50%?,Klebsiella pneumoniae?8.85%?,Escherichia coli?4.42%?and Staphylococcus aureus?4.42%?.?4?According to the results of drug sensitivity test,the resistance rate of Acinetobacter baumannii was higher than 90% to most antibiotics,but it was low to polymyxin.The resistance rate of Gram-positive cocci to penicillin was 100%,and to gentamicin,oxacillin,erythromycin,ciprofloxacin was higher than 80%,but it was relatively sensitive to linazolamine,teicoplanin and vancomycin.Conclusions:The incidence of pulmonary infection in adults after cardiopulmonary bypass is different among different diseases,among which the incidence of pulmonary infection after macrovascular surgery is the highest.Age>60 years old,preoperative red blood cell count<4×10¹²/L,preoperative albumin<30g/L,cardiopulmonary bypass time>120 minutes,aortic occlusion time>80 minutes,postoperative creatinine>110?mol/L,postoperative heart rate>100 beats/min,postoperative Sa O2<95%,postoperative Lactic acid value>4mmol / L,minimum OI<200mm Hg within 12 hours after surgery,red blood cell transfusion within 24 hours after operation>4U and mechanical ventilation time>48h etc,are independent risk factors for pulmonary infection.?3?Gram-negative bacteria were the main pathogens of pulmonary infection in this studyincluding Acinetobacter baumannii,Pseudomonas aeruginosa and Klebsiella pneumoniae,etc.Staphylococcus aureus was the main gram-positive bacteria and Candida albicans was the most common fungus.?4?Multi-drug-resistant bacteria existed in the pathogenic bacteria of pulmonary infection,and antibiotics should be selected reasonably according to the results of drug sensitivity test.