Risk factors for pulmonary infection in patients after cardiac surgery: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CAI Wenqian ,  WU Dequan , SUN Yue , LIU Bo

1. Nursing school of Anhui Medical University, The Second Hospital of Anhui Medical University, Hefei, 230032, P. R. China;

Corresponding author：

WU Dequan, Email: 2981288742@qq.com

Keywords：

Cardiac surgery; postoperative pulmonary infection; risk factors; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202310069

Video：

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Objective To systematically evaluate the risk factors for pulmonary infection after cardiac surgery. Methods A computer search was performed to collect researches on risk factors for pulmonary infection in patients after cardiac surgery from the databases, including CNKI, Wanfang, VIP, CBM, PubMed, The Cochrane Library, EBSCO, CINAHL, Web of Science, EMbase from the inception to August 2023. Two researchers independently extracted data and assessed the literature according to the inclusion and exclusion criteria, and the quality of the literature was evaluated using the Newcastle-Ottawa Scale (NOS). The meta-analysis was performed using RevMan 5.4 software. Results A total of 23 studies covering 24348 patients were selected, including 21 case-control studies and 2 cohort studies. The NOS scores were≥6 points. The results of meta-analysis displayed that age (OR=2.16, 95%CI 1.80 to 2.59, P<0.001), smoking history (OR=1.91, 95%CI 1.67 to 2.18, P<0.001), pulmonary disease (OR=1.61, 95%CI 1.40 to 1.85, P<0.001), diabetes mellitus (OR=1.62, 95%CI 1.26 to 2.08, P<0.001), operation time (OR=2.54, 95%CI 1.86 to 3.46, P<0.001), extracorporeal circulation time (OR=2.30, 95%CI 1.94 to 2.71, P<0.001), blood transfusion (OR=2.55, 95%CI 2.04 to 3.20, P<0.001), postoperative mechanical ventilation time (OR=2.78, 95%CI 2.34 to 3.30, P<0.001), tracheal intubation time (OR=3.93, 95%CI 2.45 to 6.31, P<0.001) and repeated tracheal intubation (OR=8.74, 95%CI 4.17 to 18.30, P<0.001) were independent risk factors for pulmonary infection in patients after cardiac surgery. Conclusion Age, smoking history, pulmonary disease, diabetes mellitus, operation time, extracorporeal circulation time, blood transfusion, postoperative mechanical ventilation time, tracheal intubation time, and repeated tracheal intubation are risk factors for pulmonary infection in patients after cardiac surgery. It can be used as a reference to strengthen perioperative evaluation and nursing of high-risk patients and reduce the incidence of pulmonary infection.

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24.	Topal AE, Eren MN. Risk factors for the development of pneumonia post cardiac surgery. Cardiovasc J Afr, 2012, 23(4): 212-215.
25.	邓佩琳, 胡振东, 吴秦风, 等. 老年冠心病冠状动脉搭桥术后肺部感染病原学及其影响因素. 中华医院感染学杂志, 2022, 32(11): 1702-1706.
26.	付绍春, 杨莉, 谭昆, 等. 老年主动脉夹层患者术后肺炎发生的相关危险因素分析. 中国社会医学杂志, 2021, 38(3): 340-343.
27.	高翠平, 孙淑玲, 肖茹, 等. 中老年心脏瓣膜置换术肺部感染危险因素调查. 中国消毒学杂志, 2023, 40(4): 284-286,290.
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29.	刘建民, 刘建斌, 叶蕾, 等. 先天性心脏病和心脏瓣膜病术后肺部感染的相关因素分析. 安徽医药, 2019, 23(4): 707-709.
30.	王雯丹, 潘彬彬, 王珊, 等. 体外循环心脏术后肺部感染的相关因素分析. 中国现代医生, 2022, 60(21): 28-31.
31.	王永莉, 宁园, 吴丽娜. 心脏瓣膜置换术后肺部感染的因素分析及预防护理对策. 全科护理, 2022, 20(18): 2580-2582.
32.	魏润生, 高海涛, 齐贺文, 等. 心脏瓣膜置换术后肺部感染影响因素及心肌酶谱的变化. 中华医院感染学杂志, 2019, 29(21): 3266-3269,3274.
33.	徐慧, 刘鸿, 管玉珍, 等. 老年冠心病患者冠状动脉旁路移植术后发生肺部感染的影响因素及其风险预测列线图模型构建. 实用心脑肺血管病杂志, 2023, 31(8): 48-53.
34.	杨书强, 康娜, 王俊生, 等. 心脏瓣膜置换术后肺部感染的影响因素及其与TNF-α基因多态性的关联. 中华医院感染学杂志, 2023, 33(11): 1650-1654.
35.	袁婷, 邱贝丽, 李燕君, 等. 心脏移植受者术后首次住院期间获得性肺部感染和肺部感染死亡的危险因素分析. 中国医药, 2020, 15(1): 41-44.
36.	张丽萍, 赵顺美. 冠状动脉旁路移植术后肺部感染相关因素分析及预防. 现代实用医学, 2018, 30(11): 1457-1459.
37.	张灵芝. 老年心脏介入术后肺部感染相关危险因素分析及护理对策. 中国当代医药, 2017, 24(16): 149-152.
38.	赵映, 刘苏, 刘淑芳, 等. 心脏大血管术后肺部感染病原学及危险因素. 中华医院感染学杂志, 2021, 31(7): 1039-1042.
39.	Ailawadi G, Chang HL, O'Gara PT, et al. Pneumonia after cardiac surgery: Experience of the National Institutes of Health/Canadian Institutes of Health Research Cardiothoracic Surgical Trials Network. J Thorac Cardiovasc Surg, 2017, 153(6): 1384-1391.
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46.	尚娟娟, 马小丹, 刘慧, 等. 心外科开胸手术部位感染的主要危险因素及病原菌分布研究. 心脑血管病防治, 2021, 21(5): 516-518.
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1. Mali S, Haghaninejad H. Pulmonary complications following cardiac surgery. Arch Med Sci Atheroscler Dis, 2019, 4: e280-e285.
2. Tsao CW, Aday AW, Almarzooq ZI, et al. Heart disease and stroke statistics-2023 update: A report from the American Heart Association. Circulation, 2023, 147(8): e93-e621.
3. 宋亚佩, 吴艳, 翟继卫. 心外科手术后医院感染特点及影响因素研究. 中国消毒学杂志, 2021, 38(11): 832-835.
4. 毛文杰, 蒋蓉娟, 玉红, 等. 术中通气模式对体外循环下成人心脏手术后肺部并发症影响的回顾性队列研究. 中国胸心血管外科临床杂志, 2022, 29(3): 356-365.
5. 施舟, 陈振星, 王斌, 等. 心脏外科术后肺部并发症的危险因素. 临床麻醉学杂志, 2021, 37(10): 1023-1028.
6. 李霞, 马华怡, 赖军华, 等. 心脏外科术后肺部并发症研究进展. 实用医学杂志, 2023, 39(4): 510-513.
7. 伊加提·司马义, 居来提·肉扎洪, 阿布都乃比·麦麦提艾力. 成人心外科围手术期肺部感染患者死亡的危险因素. 中华医院感染学杂志, 2022, 32(9): 1333-1336.
8. Zukowska A, Kaczmarczyk M, Listewnik M, et al. Impact of post-operative infection after CABG on long-term survival. J Clin Med, 2023, 12(9): 3125.
9. de la Varga-Martínez O, Gómez-Sánchez E, Muñoz MF, et al. Impact of nosocomial infections on patient mortality following cardiac surgery. J Clin Anesth, 2021, 69: 110104.
10. 张静, 李娟, 朱鑫瀛, 等. 心脏外科术后肺部并发症发生风险的列线图预测模型构建. 安徽医学, 2022, 43(9): 1012-1017.
11. Ho CH, Chen YC, Chu CC, et al. Postoperative complications after coronary artery bypass grafting in patients with chronic obstructive pulmonary disease. Medicine (Baltimore), 2016, 95(8): e2926.
12. Tanner TG, Colvin MO. Pulmonary complications of cardiac surgery. Lung, 2020, 198(6): 889-896.
13. 杨滢, 刘济. 心外科手术患者医院感染危险因素分析. 中国消毒学杂志, 2022, 39(3): 190-192.
14. Gao Y, Wang C, Wang Y, et al. Establishment and validation of a nomogram to predict hospital-acquired infection in elderly patients after cardiac surgery. Clin Interv Aging, 2022, 17: 141-150.
15. Yao X, Li N, Lu R, et al. Development of a nomogram for predicting nosocomial infections among patients after cardiac valve replacement surgery. J Clin Nurs, 2023, 32(7-8): 1466-1475.
16. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
17. Wang D, Huang X, Wang H, et al. Risk factors for postoperative pneumonia after cardiac surgery: A prediction model. J Thorac Dis, 2021, 13(4): 2351-2362.
18. Allou N, Bronchard R, Guglielminotti J, et al. Risk factors for postoperative pneumonia after cardiac surgery and development of a preoperative risk score. Crit Care Med, 2014, 42(5): 1150-1156.
19. Vidal C, Pasqualotto R, James A, et al. Predictive risk factors for postoperative pneumonia after heart transplantation. BMC Anesthesiol, 2020, 20(1): 8.
20. Kilic A, Ohkuma R, Grimm JC, et al. A novel score to estimate the risk of pneumonia after cardiac surgery. J Thorac Cardiovasc Surg, 2016, 151(5): 1415-1420.
21. El Solh AA, Bhora M, Pineda L, et al. Nosocomial pneumonia in elderly patients following cardiac surgery. Respir Med, 2006, 100(4): 729-736.
22. Hua LJ, Kong LX, Hu JN, et al. Perioperative risk factors for post-operative pneumonia after type A acute aortic dissection surgery. Curr Med Sci, 2023, 43(1): 69-79.
23. Vera Urquiza R, Bucio Reta ER, Berríos Bárcenas EA, et al. Risk factors for the development of postoperative pneumonia after cardiac surgery. Arch Cardiol Mex, 2016, 86(3): 203-207.
24. Topal AE, Eren MN. Risk factors for the development of pneumonia post cardiac surgery. Cardiovasc J Afr, 2012, 23(4): 212-215.
25. 邓佩琳, 胡振东, 吴秦风, 等. 老年冠心病冠状动脉搭桥术后肺部感染病原学及其影响因素. 中华医院感染学杂志, 2022, 32(11): 1702-1706.
26. 付绍春, 杨莉, 谭昆, 等. 老年主动脉夹层患者术后肺炎发生的相关危险因素分析. 中国社会医学杂志, 2021, 38(3): 340-343.
27. 高翠平, 孙淑玲, 肖茹, 等. 中老年心脏瓣膜置换术肺部感染危险因素调查. 中国消毒学杂志, 2023, 40(4): 284-286,290.
28. 林丽珠, 王明亚, 敖虎山. 冠状动脉旁路移植术后肺部感染的危险因素分析. 广东医学, 2017, 38(14): 2161-2164.
29. 刘建民, 刘建斌, 叶蕾, 等. 先天性心脏病和心脏瓣膜病术后肺部感染的相关因素分析. 安徽医药, 2019, 23(4): 707-709.
30. 王雯丹, 潘彬彬, 王珊, 等. 体外循环心脏术后肺部感染的相关因素分析. 中国现代医生, 2022, 60(21): 28-31.
31. 王永莉, 宁园, 吴丽娜. 心脏瓣膜置换术后肺部感染的因素分析及预防护理对策. 全科护理, 2022, 20(18): 2580-2582.
32. 魏润生, 高海涛, 齐贺文, 等. 心脏瓣膜置换术后肺部感染影响因素及心肌酶谱的变化. 中华医院感染学杂志, 2019, 29(21): 3266-3269,3274.
33. 徐慧, 刘鸿, 管玉珍, 等. 老年冠心病患者冠状动脉旁路移植术后发生肺部感染的影响因素及其风险预测列线图模型构建. 实用心脑肺血管病杂志, 2023, 31(8): 48-53.
34. 杨书强, 康娜, 王俊生, 等. 心脏瓣膜置换术后肺部感染的影响因素及其与TNF-α基因多态性的关联. 中华医院感染学杂志, 2023, 33(11): 1650-1654.
35. 袁婷, 邱贝丽, 李燕君, 等. 心脏移植受者术后首次住院期间获得性肺部感染和肺部感染死亡的危险因素分析. 中国医药, 2020, 15(1): 41-44.
36. 张丽萍, 赵顺美. 冠状动脉旁路移植术后肺部感染相关因素分析及预防. 现代实用医学, 2018, 30(11): 1457-1459.
37. 张灵芝. 老年心脏介入术后肺部感染相关危险因素分析及护理对策. 中国当代医药, 2017, 24(16): 149-152.
38. 赵映, 刘苏, 刘淑芳, 等. 心脏大血管术后肺部感染病原学及危险因素. 中华医院感染学杂志, 2021, 31(7): 1039-1042.
39. Ailawadi G, Chang HL, O'Gara PT, et al. Pneumonia after cardiac surgery: Experience of the National Institutes of Health/Canadian Institutes of Health Research Cardiothoracic Surgical Trials Network. J Thorac Cardiovasc Surg, 2017, 153(6): 1384-1391.
40. 黄浩. 心脏瓣膜置换术后肺部并发症的多因素分析. 心理月刊, 2018(7): 178-179.
41. 张涛, 曹东航, 丁进峰, 等. 心脏外科术后感染的影响因素及其早期评估. 中华医院感染学杂志, 2022, 32(9): 1328-1332.
42. 刘兴红, 王慧华, 胡玉婷, 等. 冠状动脉旁路移植患者术后肺部并发症预防及管理的证据总结. 护理学杂志, 2023, 38(16): 46-52.
43. Wang B, Chen Z, Zhao R, et al. Development and validation of a nomogram to predict postoperative pulmonary complications following thoracoscopic surgery. PeerJ, 2021, 9: e12366.
44. Agostini PJ, Lugg ST, Adams K, et al. Risk factors and short-term outcomes of postoperative pulmonary complications after VATS lobectomy. J Cardiothorac Surg, 2018, 13(1): 28.
45. Panzer AR, Lynch SV, Langelier C, et al. Lung microbiota is related to smoking status and to development of acute respiratory distress syndrome in critically ill trauma patients. Am J Respir Crit Care Med, 2018, 197(5): 621-631.
46. 尚娟娟, 马小丹, 刘慧, 等. 心外科开胸手术部位感染的主要危险因素及病原菌分布研究. 心脑血管病防治, 2021, 21(5): 516-518.
47. 董柱, 曹一秋, 张本, 等. 人工瓣膜置换术后感染的危险因素分析及预防策略. 临床心血管病杂志, 2019, 35(4): 300-305.
48. Admass BA, Ego BY, Tawye HY, et al. Post-operative pulmonary complications after thoracic and upper abdominal procedures at referral hospitals in Amhara region, Ethiopia: A multi-center study. Front Surg, 2023, 10: 1177647.
49. 水清, 曾显阁. 512例心外科术后病原菌感染临床特征与危险因素分析. 中国病原生物学杂志, 2023, 18(2): 215-219.
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