【罂粟摘要】心脏手术后医院感染对患者死亡率的影响
心脏手术后医院感染对患者死亡率的影响
确定心脏手术患者医院感染率，并明确危险因素以及这些感染对患者死亡率的影响。
前瞻性观察研究。
重症监护病区(ICU)。
共纳入2011年1月至2016年1月在克里尼科大学巴拉多利德医院接受心脏手术的1097名成人患者。
无。
术前、术中和术后的内科、外科和麻醉学变量。
共有111例(10.1%)患者在术后期间发生医院感染，肺炎是最常见的医院感染(4.2%)；院内感染发生的三个独立的危险因素：体外循环时长、肾功能衰竭和急诊手术。发生医院感染的患者ICU住院时间明显增加，(16.6 ± 38.8 vs. 4.4 ± 17.8, P < 0.001)；发生医院感染的患者死亡率(18%)显著高于未发生医院感染的患者(5%)(P < 0.001)。无医院感染患者的90天存活率较高(LOG排名27.55，P < 0.001)；90天死亡率的动态模拟显示第1周，体外循环时间(HR = 1.00, 95% CI 1.00–1.02, P < 0.001) 和急诊手术(HR = 0.12, 95% CI 0.04–0.37, P < 0.001)是影响死亡率的主要危险因素；第1周后，医院感染(HR = 6.23，95%CI2.49-15.63，P < 0.001)是主要的危险因素；其次是体外循环时间(HR = 1.01, 95% CI 1.00–1.01, P = 0.001)和欧洲心血管危险因素评分(HR = 1.03, 95% CI 1.00–1.06, P = 0.008)。
心脏手术后医院感染是构成术后第一周死亡的主要独立危险因素；数据表明，心脏手术后可优先预防术后医院感染，以改善患者的预后。
de la Varga-Martínez O, Gómez-Sánchez E, et al.Impact of nosocomial infections on patient mortality following cardiac surgery.J Clin Anesth 2020 Nov 19;69.
Impact of nosocomial infections on patient mortality following
cardiac surgery
Study objective: To determine the rate of nosocomial infection among patients undergoing cardiac surgery and to identify risk factors and the impact of these infections on patient mortality.
Design: Prospective observational study.
Setting: Intensive Care Unit (ICU).
Patients: 1097 adult patients who underwent cardiac surgery at Hospital Clínico Universitario de Valladolid between January 2011 and January 2016.
Interventions: None.
Measurements: Preoperative, intraoperative and postoperative medical, surgical and anaesthetic variables.
Main results: A total of 111 patients (10.1%) acquired a nosocomial infection in the postoperative period. Pneumonia was the most frequent (4.2%) nosocomial infection. Three independent risk factors for the development of a nosocomial infection were identified: cardiopulmonary bypass time, kidney failure and emergency surgery. The stay in the ICU was significantly higher in patients who developed a nosocomial infection (16.6 ± 38.8 vs. 4.4 ± 17.8, P < 0.001). The mortality rate of patients who acquired a nosocomial infection was significantly greater (18%) than that of patients who did not acquire a nosocomial infection (5%) (P < 0.001). The 90-day survival was greater in the group of patients without nosocomial infection (log rank 27.55, P < 0.001). The dynamic modelling of 90-day mortality revealed that in the first week, cardiopulmonary bypass time (HR = 1.00, 95% CI 1.00–1.02, P < 0.001) and emergency surgery (HR = 0.12, 95% CI 0.04–0.37, P < 0.001) were the most important risk factors for mortality, while after the first week, nosocomial infection (HR = 6.23, 95% CI 2.49–15.63, P < 0.001) was the main risk factor, followed by cardiopulmonary bypass time (HR = 1.01, 95% CI 1.00–1.01, P = 0.001) and EuroSCORE (HR = 1.03, 95% CI 1.00–1.06, P = 0.008).
Conclusions: Nosocomial infections after cardiac surgery constitute the main independent risk factor for mortality after the first week of surgery. These data suggest that its prevention following cardiac surgery must be prioritised to improve patient outcomes.Local Anesthesia Without Sedation During Thrombectomy for Anterior Circulation Stroke Is Associated With Worse Outcome.
翻译：吴学艳
编辑：佟睿
审校：曹莹