Miyata Eriko, Tanaka Atsushi, Emori Hiroki, Taruya Akira, Miyai Shinji, Sakagoshi Nobuo
Intensive Care Unit, Kinan Hospital, Tanabe, Japan.
Department of Cardiovascular Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama, 641-8509, Japan.
Gen Thorac Cardiovasc Surg. 2017 Feb;65(2):96-101. doi: 10.1007/s11748-016-0710-8. Epub 2016 Sep 9.
Pneumonia after cardiovascular surgery is the leading cause of mortality. Postoperative aspiration pneumonia becomes a critical issue in the management of cardiovascular surgery in the aging society. The aim of this study was to investigate the incidence and risk factors of aspiration pneumonia after cardiovascular surgery for elderly patients.
This study consisted of 123 elderly patients (>65 years old) who survived their final extubation following cardiovascular surgery at Kinan Hospital. Patients were divided into aspiration pneumonia and no pneumonia groups. Postoperative aspiration pneumonia was diagnosed by two independent physicians according to the nursing- and healthcare-associated pneumonia guidelines by the Japanese Respiratory Society.
Among the patients, 12 (9.8 %) had aspiration pneumonia. There were no differences in patients' characteristics between the groups except for a history of cerebral vascular disorder (aspiration pneumonia 42 % vs no pneumonia 15 %, p = 0.04) and ejection fraction (EF) (aspiration pneumonia 56 ± 21 % vs no pneumonia 66 ± 13 %, p = 0.02). Only six (5 %) patients needed more than 12 h intubation. There was no difference in the operative factors between the groups. Neurological deficit was more frequently observed in the aspiration pneumonia group (33 vs 5 %, p = 0.005). Multivariable logistic regression analysis showed that the history of cerebral vascular disorder and neurological deficit after surgery was independent risk factors for aspiration pneumonia after cardiovascular surgery.
Our results could assist in screening elderly patients who should be more carefully evaluated before oral nutrition to minimize morbidity and mortality after cardiovascular surgery.
心血管手术后肺炎是主要的死亡原因。在老龄化社会中，术后吸入性肺炎成为心血管手术管理中的一个关键问题。本研究的目的是调查老年患者心血管手术后吸入性肺炎的发生率及危险因素。
本研究纳入了纪南医院123例心血管手术后最终拔管存活的老年患者（年龄>65岁）。患者被分为吸入性肺炎组和无肺炎组。两名独立医生根据日本呼吸学会的护理和医疗相关肺炎指南诊断术后吸入性肺炎。
患者中，12例（9.8%）发生吸入性肺炎。两组患者的特征除脑血管疾病史（吸入性肺炎组42% vs无肺炎组15%，p = 0.04）和射血分数（EF）（吸入性肺炎组56±21% vs无肺炎组66±13%，p = 0.02）外无差异。仅6例（5%）患者需要超过12小时的插管。两组手术因素无差异。吸入性肺炎组神经功能缺损的发生率更高（33% vs 5%，p = 0.005）。多变量逻辑回归分析显示，脑血管疾病史和术后神经功能缺损是心血管手术后吸入性肺炎的独立危险因素。
我们的结果有助于筛查在进行肠内营养前应更仔细评估的老年患者，以尽量降低心血管手术后的发病率和死亡率。
