心臓血管外科手術後における呼吸不全と呼吸器感染症の発生因子

Risk Factors for Post-operative Respiratory Failure and Respiratory Tract Infections Following Cardiovascular Surgery

心臓血管外科手術後の呼吸不全と呼吸器感染症の発生は，在院日数延長，医療費と死亡率の上昇1～3）につながり，患者アウトカムに影響を与える重要な合併症である．われわれの研究4）においても，呼吸不全と呼吸器感染症の発生は，術後のリハビリテーション（以下，リハ）進行遅延に有意に影響しており，非発生と比較してリハ進行遅延のリスクを約2倍高めることを明らかにした．また，心臓血管外科手術後の呼吸不全と呼吸器感染

Introduction：Respiratory failure and respiratory tract infections are frequently observed as post-operative pulmonary complications, and significantly contribute to morbidity and mortality. However, the risk factors of post-operative respiratory failure and respiratory tract infections are controversial, and how these factors affect on incidence of complications is still unclear.

Objective：To identify risk factors of post-operative respiratory failure and respiratory tract infections, and evaluate its impact on incidences after cardiovascular surgery.

Methods：From June 2013 to May 2015, adult patients undergoing cardiovascular surgery in the department of cardiovascular surgery and post-operative rehabilitation of Nagasaki University Hospital （Nagasaki, Japan） were retrospectively investigated.

Results：Fifty-two of 416 patients（12.5%）suffered from post-operative respiratory failure and respiratory tract infections. Identified risk stratification indicates the relevant operative factors were more important than pre-operative factors. The operative time （OR 1.696, 95％ CI 1.302～2.211）, post-operative water balance （OR 1.025, 95％ CI 1.004～1.046）and emergency operation （OR 3.607, 95％ CI 1.492～8.716）were significant independent risk factors in the development of post-operative respiratory failure and respiratory tract infections.

Conclusions：These results indicated that the operative factors are more important as onset of post-operative respiratory failure and respiratory tract infections after cardiovascular surgery.