2014—2023年手术后肺炎临床分布特点及变化趋势

Clinical distribution characteristics and changing trend of postoperative pneumonia, 2014-2023

摘要:

目的 分析手术后肺炎临床分布特点及变化趋势,为手术后肺炎的进一步监测和管理提供依据。方法 收集南京医科大学第一附属医院2014—2023年手术后肺炎患者的临床资料,回顾性分析手术后肺炎发病率、呼吸机相关肺炎(VAP)占比变化趋势及手术后肺炎发生时间和病原体分布,以及各科室手术后肺炎发病率。结果 2014—2023年全院共有653 609例患者接受外科手术,手术例次数为676 245次,其中有2 934例次发生手术后肺炎,手术后肺炎发病率为0.43%。手术后肺炎患者平均年龄为(59.76±16.53)岁,男性占比68.58%;手术后肺炎发病率由2014年的 2.00% 降至2023年的0.10%,VAP占比由2014年的9.92%上升至2023年的99.10%,差异均有统计学意义(均P＜0.001)。手术后肺炎发生在术后7、10、30 d内的分别占65.81%、78.80%、95.64%,发生率居前三的科室分别为心脏大血管外科(5.277%)、神经外科(2.114%)和胸外科(1.130%);感染病原体以革兰阴性菌为主(77.58%)。结论 手术后肺炎发病率呈下降趋势,其中VAP患者应作为后续改进工作的重点关注对象,心脏血管外科、神经外科和胸外科则是手术后肺炎的重点关注科室,手术后10 d内应作为手术后肺炎的重点关注时间段。

Abstract:

Objective To analyze the clinical distribution characteristics and changing trend of postoperative pneumonia (POP), and provide basis for further monitoring and management of POP. Methods Clinical data of POP patients in the First Affiliated Hospital with Nanjing Medical University from 2014-2023 were collected. The incidence of POP, the changing trend of proportion of ventilator-associated pneumonia (VAP), the occurrence time, pathogen distribution, and incidence of POP in various departments were analyzed retrospectively. Results From 2014 to 2023, a total of 653 609 patients in the hospital received surgery, with 676 245 times of operations, out of which 2 934 cases had POP, and the incidence of POP was 0.43%. The average age of POP patients was (59.76±16.53) years old, with 68.58% being male. The incidence of POP decreased from 2.00% in 2014 to 0.10% in 2023, and the proportion of VAP increased from 9.92% in 2014 to 99.10% in 2023, with statistically significant differences (all P<0.001). POP occurred within 7, 10, and 30 days after surgery accounted for 65.81%, 78.80%, and 95.64%, respectively. The top three departments with the highest incidences were cardiovascular surgery (5.277%), neurosurgery (2.114%), and thoracic surgery (1.130%). The main pathogen of infection was Gram-negative bacteria (77.58%). Conclusion The incidence of POP shows a downward trend. VAP patients should be the focus of follow-up improvement work. Departments of cardiovascular surgery, neurosurgery, and thoracic surgery are the key departments of POP, and 10 days after surgery should be the critical period of POP.