非体外循环下冠状动脉旁路移植术后肺部感染的多因素分析

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1、授予单位代码10089学号或申请号20153277中国图书分类号R654.2HebeiMedicalUniversity硕士学位论文专业学位非体外循环下冠状动脉旁路移植术后肺部感染的多因素分析研究生：李苗苗导师：刘林力教授专业：外科学二级学院：河北医科大学第二医院2018年3目录中文摘要·········································································································1英文摘要······································

2、···································································2研究论文非体外循环下冠状动脉旁路移植术后肺部感染的多因素分析前言··········································································································4材料与方法················································································

3、··············5结果··········································································································7附表··········································································································8讨论·························································

4、·················································12结论··········································································································15参考文献··································································································16综述冠状动脉旁路移植术后肺部感染研究现状·······

5、······························20致谢·················································································································36个人简历·········································································································37中文摘要非体外循环下冠状动脉旁路移植术后肺部感染的多因素分析摘要

6、目的：非体外循环下冠状动脉旁路移植术（OPCABG）已经成为冠心病的外科治疗，尤其是重度冠状动脉病变再血管化治疗的标准方法。术后肺部感染是OPCABG常见的并发症之一，通过研究其相关高危因素，力求做好二级预防，调整围手术期治疗策略，对改善患者预后有重要意义。方法：研究对象为2015年10月至2017年10月在河北医科大学第二医院行OPCABG的患者。记录患者相关信息，参照疾病预防与控制中心(CDC)的标准，进行肺部感染的诊断。进行统计分析。结果：本研究的764例患者中，31人出现肺部感染，发病率为4.1%，术后肺部感染与死亡率明显相关。术后气管插管留置时间超过24h、术后心房颤

7、动、室间隔增厚、左心房内径增大、左心室内径增大、射血分数降低是OPCABG术后肺部感染的危险因素。多因素Logistic回归分析显示气管插管留置时间超过24小时及术后心房颤动与OPCABG术后肺部感染关系密切。结论：早期拔出气管插管有利于降低术后肺部感染的发生几率。术后房颤与术后肺部感染关系密切。术前超声结果对术后肺部感染有一定的预示作用。术前戒烟的患者，术后肺部感染的发生率可与不吸烟患者无明显差异。术前血糖控制良好的糖尿病患者，术后肺部感染的发生率可与非糖尿病者无明显差异。围手术期管理可能