心室辅助患者感染的研究进展
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摘要
心室辅助可用于支持心衰患者心脏功能的恢复,还可用于心脏移植前的过渡支持与无法移植患者的永久辅助治疗。感染是患者心室辅助过程中的主要并发症之一,护理人员全程参与心室辅助患者感染的预防与管理,并在其中发挥着不可或缺的重要作用。因此文章对心室辅助患者感染从定义、现状、影响因素等方面进行综述,并从风险评估和临床管理方面提出心室辅助感染的预防措施,以期为该人群的感染预防与控制提供一些借鉴与展望。
Ventricular assist could be used to support cardiac function recovery in heart failure patients,as well as for transitional support before heart transplantation and permanent adjuvant therapy in patients without heart transplantation.Infection was one of the main complications in patients' ventricular assist process.The nursing staff was involved in the prevention and management of ventricular assist patients' infection,and played an indispensable role in this process.Therefore,the article reviewed the definition,current situation and influencing factors of ventricular assisted infection in patients provided prevention measures on risk assessment and clinical management of ventricular assist patients' infection,so as to provide some references and prospects for infection prevention and control in this population.
Ventricular assist could be used to support cardiac function recovery in heart failure patients,as well as for transitional support before heart transplantation and permanent adjuvant therapy in patients without heart transplantation.Infection was one of the main complications in patients' ventricular assist process.The nursing staff was involved in the prevention and management of ventricular assist patients' infection,and played an indispensable role in this process.Therefore,the article reviewed the definition,current situation and influencing factors of ventricular assisted infection in patients provided prevention measures on risk assessment and clinical management of ventricular assist patients' infection,so as to provide some references and prospects for infection prevention and control in this population.
引文
[1] 胡盛寿.心力衰竭外科治疗现状与进展[J].中国循环杂志,2016,31(3):209-213.DOI:10.3969/j.issn.1000-3614.2016.03.001.
[2] BENJAMIN E J,VIRANI S S,CALLAWAY C W,et al.Heart Disease and Stroke Statistics-2018 Update:A Report From the American Heart Association[J].Circulation,2018,137(12):e67-e442.DOI:10.1161/CIR.0000000000000558.
[3] 张岩,孙寒松,胡盛寿.左心室辅助血泵及其临床应用研究进展[J].中国胸心血管外科临床杂志,2017,24(2):152-155.
[4] YANCY C W,JESSUP M,BOZKURT B,et al.2013 ACCF/AHA Guideline for the Management of Heart Failure:Executive Summary[J].Circulation,2013,62(16):E147-E239.
[5] 段文涛.左心室辅助装置治疗终末期心力衰竭的应用研究进展[J].内科,2018,13(1):52-54.DOI:10.16121/j.cnki.cn45-1347/r.2018.01.16.
[6] KIRKLIN J K,PAGANI F D,KORMOS R L,et al.Eighth annual INTERMACS report:special focus on framing the impact of adverse events[J].Journal of Heart & Lung Transplantation,2015,34(12):1495-1504.DOI:10.1016/j.healun.2015.10.003.
[7] 周敏,蒋亚娟.支气管哮喘急性发作合并急性上呼吸道感染患者护理风险管理效果研究[J].护理管理杂志,2017,17(11):834-836.
[8] 詹昱新,乐革芬,欧阳燕,等.集束化干预措施在神经外科多重耐药菌感染管理中的应用探讨[J].护理管理杂志,2017,17(7):493-495.
[9] FELDMAN D,PAMBOUKIAN S V,TEUTEBERG J J,et al.The 2013 International Society for Heart and Lung Transplantation Guidelines for mechanical circulatory support:executive summary[J].Journal of Heart & Lung Transplantation the Official Publication of the International Society for Heart Transplantation,2013,32(2):157-187.DOI:10.1016/j.healun.2012.09.013.
[10] KOVAL C E,RAKITA R.Ventricular assist device related infections and solid organ transplantation[J].American Journal of Transplantation,2013,13(s4):348-354.DOI:10.1111/ajt.12126.
[11] AISSAOUI N,JOUAN J,GOURJAULT M,et al.Understanding left ventricular assist devices[J].Blood Purification,2018,46(4):292-300.
[12] GORDON R J,WEINBERG A D,PAGANI F D,et al.Prospective,multicenter study of ventricular assist device infections[J].Circulation,2013,127(6):691-702.
[13] The Data and Clinical Coordinating Center University of Alabama at Birmingham.INTERMACS Quarterly Statistical Report[EB/OL].[2018-08-01].http://www.uab.edu/medicine/intermacs/ reports/public-statistical-reports.
[14] ASLAM S,XIE R,COWGER J,et al.Bloodstream infections in mechanical circulatory support device recipients in the IMACS registry:epidemiology,risk factors,and mortality[J].Journal of Heart & Lung Transplantation,2018,37(8):1013-1020.DOI:10.1016/j.healun.2018.04.006.
[15] PIERI M,MüLLER M,SCANDROGLIO A M,et al.Surgical treatment of mediastinitis with omentoplasty in ventricular assist device patients:report of referral center experience[J].ASAIO Journal,2016,62(6):666-670.DOI:10.1097/MAT.0000000000000418.
[16] HéQUET D,KRALIDIS G,CARREL T,et al.Ventricular assist devices as bridge to heart transplantation:impact on post-transplant infections[J].BMC Infectious Diseases,2016,16(1):1-9.DOI:10.1186/s12879-016-1658-0.
[17] ABE R,SHIBATA S C,SAITO S,et al.Factors related to the severity of early postoperative infection after heart transplantation in patients surviving prolonged mechanical support periods:experience at a single university[J].Journal of Cardiothoracic & Vascular Anesthesia,2018,32(1):53-59.DOI:10.1053/j.jvca.2017.07.004.
[18] HARVEY L,HOLLEY C,COGSWELL R,et al.Driveline infection after Heart Mate II associated with lower rates of cardiac transplantation and increased incidence of sepsis in bridge-to-transplant population[J].Minnesota Medicine,2014,97(5):40.
[19] AGRAWAL S,GARG L,SHAH M,et al.Thirty-day readmissions after left ventricular assist device implantation in the United States:insights from the nationwide readmissions database[J].Circulation Heart Failure,2018,11(3):e4628.DOI:10.1161/CIRCHEARTFAILURE.117.004628.
[20] COOK J L,GRADY K L,COLVIN M,et al.Sex differences in the care of patients with advanced heart failure[J].Circ Cardiovasc Qual Outcomes,2015,8(1):56-59.DOI:10.1161/CIRCOUTCOMES.115.001730.
[21] O'HORO J C,ABU SALEH O M,STULAK J M,et al.Left ventricular assist device infections:a systematic review[J].ASAIO Journal,2018,64(3):287-294.DOI:10.1097/MAT.0000000000000684.
[22] CHEN S,CANTOR R S,AUERBACH S,et al.Outcomes after infections in adolescents and young adults with continuous-flow left ventricular assist devices[J].ASAIO Journal,2019,65(4):380-388.DOI:10.1097/MAT.0000000000000816.
[23] LANDER M M,KUNZ N,DUNN E,et al.Substantial reduction in driveline infection rates with the modification of driveline dressing protocol[J].Journal of Cardiac Failure,2018,24(11):746-752.DOI:10.1016/j.cardfail.2018.07.464.
[24] FOREST S J,XIE R,KIRKLIN J K,et al.Impact of body mass index on adverse events following implantation of left ventricular assist devices:an IMACS registry analysis[J].Journal of Heart & Lung Transplantation,2018,37(10):1207-1217.DOI:10.1016/j.healun.2018.06.004.
[25] HAN J,MAURO C M,KURLANSKY P A,et al.Impact of obesity on readmission in patients with left ventricular assist devices[J].Annals of Thoracic Surgery,2018,105(4):1192-1198.
[26] LERMAN D T,HAMILTON K W,BYRNE D,et al.The impact of infection among left ventricular assist device recipients on post-transplantation outcomes:a retrospective review each author listed on this manuscript made tremendous contributions to this paper[J].Transplantation Infection Disease,2018,20(6):e12995.DOI:10.1111/tid.12995.
[27] 闫睿.肾功能不全和抑郁均增加心室辅助装置的感染风险[J].中国循证心血管医学杂志,2013,127(6):691-702.
[28] KOVAL C E,THUITA L,MOAZAMI N,et al.Evolution and impact of drive-line infection in a large cohort of continuous-flow ventricular assist device recipients[J].Journal of Heart & Lung Transplantation,2014,33(11):1164-1172.DOI:10.1016/j.healun.2014.05.011.
[29] 白龙,田海,陈巍,等.左心室辅助装置治疗终末期心力衰竭进展[J].哈尔滨医科大学学报,2016,50(2):185-188.
[30] BRATZLER D W,DELLINGER E P,OLSEN K M,et al.Clinical practice guidelines for antimicrobial prophylaxis in surgery[J].Surgical Infections,2013,14(1):73-156.DOI:10.1089/sur.2013.9999.
[31] 楼洋,陈献国,许博,等.急性心肌梗死患者主动脉内球囊反搏术后下呼吸道感染的风险与预后研究[J].中华医院感染学杂志,2016,26(3):575-577.DOI:10.11816/cn.ni.2016-152664.
[32] SMITH E M,FRANZWA J.Chronic outpatient management of patients with a left ventricular assist device[J].Journal of Thoracic Disease,2015,7(12):2112-2124.DOI:10.3978/j.issn.2072-1439.2015.10.28.
[33] ABURJANIA N,SHERAZI S,TCHANTCHALEISHVILI V,et al.Stopping conventional showering decreases Pseudomonas infections in left ventricular assist device patients[J].The International Journal of Artificial Organs,2017,40(6):282-285.DOI:10.5301/ijao.5000590.
[34] CAGLIOSTRO B,LEVIN A P,FRIED J,et al.Continuous-flow left ventricular assist devices and usefulness of a standardized strategy to reduce drive-line infections[J].Journal of Heart & Lung Transplantation,2016,35(1):108-114.DOI:10.1016/j.healun.2015.06.010.
[35] 王亚丽,张莉,刘宏,等.改良早期预警评分识别病情临床应用现状[J].护理管理杂志,2017,17(5):359-361.
[36] 赵明,何锦华,金珊,等.感染可能性评分对输尿管软镜术后尿源性脓毒血症的筛查预测效果分析[J].中华医院感染学杂志,2018,28(24):3823-3826.DOI:10.11816/cn.ni.2018-173966.
[37] CHRISTINE K.LVAD infection during bridge-to-transplant,unique aspects of treatment and prevention[J].Current Opinion in Infectious Diseases,2018,23(4):400-406.DOI:10.1097/MOT.0000000000000548.
[38] 邱建丽,李庆印.能级管理在心脏移植病房的应用与效果[J].护理管理杂志,2012,12(4):296-297.
[39] 李文莉,孙玉荣,崔颖颖,等.一例左心室辅助患者心脏移植术后的护理[J].天津护理,2018,26(3):364-366.DOI:10.3969/j.issn.1006-9143.2018.03.043.
[40] MILLER L W,ROGERS J G.Evolution of left ventricular assist device therapy for advanced heart failure:a review[J].Joumal of the American Medical Association Cardiology,2018,3(7):650-658.DOI:10.1001/jamacardio.2018.0522.
[2] BENJAMIN E J,VIRANI S S,CALLAWAY C W,et al.Heart Disease and Stroke Statistics-2018 Update:A Report From the American Heart Association[J].Circulation,2018,137(12):e67-e442.DOI:10.1161/CIR.0000000000000558.
[3] 张岩,孙寒松,胡盛寿.左心室辅助血泵及其临床应用研究进展[J].中国胸心血管外科临床杂志,2017,24(2):152-155.
[4] YANCY C W,JESSUP M,BOZKURT B,et al.2013 ACCF/AHA Guideline for the Management of Heart Failure:Executive Summary[J].Circulation,2013,62(16):E147-E239.
[5] 段文涛.左心室辅助装置治疗终末期心力衰竭的应用研究进展[J].内科,2018,13(1):52-54.DOI:10.16121/j.cnki.cn45-1347/r.2018.01.16.
[6] KIRKLIN J K,PAGANI F D,KORMOS R L,et al.Eighth annual INTERMACS report:special focus on framing the impact of adverse events[J].Journal of Heart & Lung Transplantation,2015,34(12):1495-1504.DOI:10.1016/j.healun.2015.10.003.
[7] 周敏,蒋亚娟.支气管哮喘急性发作合并急性上呼吸道感染患者护理风险管理效果研究[J].护理管理杂志,2017,17(11):834-836.
[8] 詹昱新,乐革芬,欧阳燕,等.集束化干预措施在神经外科多重耐药菌感染管理中的应用探讨[J].护理管理杂志,2017,17(7):493-495.
[9] FELDMAN D,PAMBOUKIAN S V,TEUTEBERG J J,et al.The 2013 International Society for Heart and Lung Transplantation Guidelines for mechanical circulatory support:executive summary[J].Journal of Heart & Lung Transplantation the Official Publication of the International Society for Heart Transplantation,2013,32(2):157-187.DOI:10.1016/j.healun.2012.09.013.
[10] KOVAL C E,RAKITA R.Ventricular assist device related infections and solid organ transplantation[J].American Journal of Transplantation,2013,13(s4):348-354.DOI:10.1111/ajt.12126.
[11] AISSAOUI N,JOUAN J,GOURJAULT M,et al.Understanding left ventricular assist devices[J].Blood Purification,2018,46(4):292-300.
[12] GORDON R J,WEINBERG A D,PAGANI F D,et al.Prospective,multicenter study of ventricular assist device infections[J].Circulation,2013,127(6):691-702.
[13] The Data and Clinical Coordinating Center University of Alabama at Birmingham.INTERMACS Quarterly Statistical Report[EB/OL].[2018-08-01].http://www.uab.edu/medicine/intermacs/ reports/public-statistical-reports.
[14] ASLAM S,XIE R,COWGER J,et al.Bloodstream infections in mechanical circulatory support device recipients in the IMACS registry:epidemiology,risk factors,and mortality[J].Journal of Heart & Lung Transplantation,2018,37(8):1013-1020.DOI:10.1016/j.healun.2018.04.006.
[15] PIERI M,MüLLER M,SCANDROGLIO A M,et al.Surgical treatment of mediastinitis with omentoplasty in ventricular assist device patients:report of referral center experience[J].ASAIO Journal,2016,62(6):666-670.DOI:10.1097/MAT.0000000000000418.
[16] HéQUET D,KRALIDIS G,CARREL T,et al.Ventricular assist devices as bridge to heart transplantation:impact on post-transplant infections[J].BMC Infectious Diseases,2016,16(1):1-9.DOI:10.1186/s12879-016-1658-0.
[17] ABE R,SHIBATA S C,SAITO S,et al.Factors related to the severity of early postoperative infection after heart transplantation in patients surviving prolonged mechanical support periods:experience at a single university[J].Journal of Cardiothoracic & Vascular Anesthesia,2018,32(1):53-59.DOI:10.1053/j.jvca.2017.07.004.
[18] HARVEY L,HOLLEY C,COGSWELL R,et al.Driveline infection after Heart Mate II associated with lower rates of cardiac transplantation and increased incidence of sepsis in bridge-to-transplant population[J].Minnesota Medicine,2014,97(5):40.
[19] AGRAWAL S,GARG L,SHAH M,et al.Thirty-day readmissions after left ventricular assist device implantation in the United States:insights from the nationwide readmissions database[J].Circulation Heart Failure,2018,11(3):e4628.DOI:10.1161/CIRCHEARTFAILURE.117.004628.
[20] COOK J L,GRADY K L,COLVIN M,et al.Sex differences in the care of patients with advanced heart failure[J].Circ Cardiovasc Qual Outcomes,2015,8(1):56-59.DOI:10.1161/CIRCOUTCOMES.115.001730.
[21] O'HORO J C,ABU SALEH O M,STULAK J M,et al.Left ventricular assist device infections:a systematic review[J].ASAIO Journal,2018,64(3):287-294.DOI:10.1097/MAT.0000000000000684.
[22] CHEN S,CANTOR R S,AUERBACH S,et al.Outcomes after infections in adolescents and young adults with continuous-flow left ventricular assist devices[J].ASAIO Journal,2019,65(4):380-388.DOI:10.1097/MAT.0000000000000816.
[23] LANDER M M,KUNZ N,DUNN E,et al.Substantial reduction in driveline infection rates with the modification of driveline dressing protocol[J].Journal of Cardiac Failure,2018,24(11):746-752.DOI:10.1016/j.cardfail.2018.07.464.
[24] FOREST S J,XIE R,KIRKLIN J K,et al.Impact of body mass index on adverse events following implantation of left ventricular assist devices:an IMACS registry analysis[J].Journal of Heart & Lung Transplantation,2018,37(10):1207-1217.DOI:10.1016/j.healun.2018.06.004.
[25] HAN J,MAURO C M,KURLANSKY P A,et al.Impact of obesity on readmission in patients with left ventricular assist devices[J].Annals of Thoracic Surgery,2018,105(4):1192-1198.
[26] LERMAN D T,HAMILTON K W,BYRNE D,et al.The impact of infection among left ventricular assist device recipients on post-transplantation outcomes:a retrospective review each author listed on this manuscript made tremendous contributions to this paper[J].Transplantation Infection Disease,2018,20(6):e12995.DOI:10.1111/tid.12995.
[27] 闫睿.肾功能不全和抑郁均增加心室辅助装置的感染风险[J].中国循证心血管医学杂志,2013,127(6):691-702.
[28] KOVAL C E,THUITA L,MOAZAMI N,et al.Evolution and impact of drive-line infection in a large cohort of continuous-flow ventricular assist device recipients[J].Journal of Heart & Lung Transplantation,2014,33(11):1164-1172.DOI:10.1016/j.healun.2014.05.011.
[29] 白龙,田海,陈巍,等.左心室辅助装置治疗终末期心力衰竭进展[J].哈尔滨医科大学学报,2016,50(2):185-188.
[30] BRATZLER D W,DELLINGER E P,OLSEN K M,et al.Clinical practice guidelines for antimicrobial prophylaxis in surgery[J].Surgical Infections,2013,14(1):73-156.DOI:10.1089/sur.2013.9999.
[31] 楼洋,陈献国,许博,等.急性心肌梗死患者主动脉内球囊反搏术后下呼吸道感染的风险与预后研究[J].中华医院感染学杂志,2016,26(3):575-577.DOI:10.11816/cn.ni.2016-152664.
[32] SMITH E M,FRANZWA J.Chronic outpatient management of patients with a left ventricular assist device[J].Journal of Thoracic Disease,2015,7(12):2112-2124.DOI:10.3978/j.issn.2072-1439.2015.10.28.
[33] ABURJANIA N,SHERAZI S,TCHANTCHALEISHVILI V,et al.Stopping conventional showering decreases Pseudomonas infections in left ventricular assist device patients[J].The International Journal of Artificial Organs,2017,40(6):282-285.DOI:10.5301/ijao.5000590.
[34] CAGLIOSTRO B,LEVIN A P,FRIED J,et al.Continuous-flow left ventricular assist devices and usefulness of a standardized strategy to reduce drive-line infections[J].Journal of Heart & Lung Transplantation,2016,35(1):108-114.DOI:10.1016/j.healun.2015.06.010.
[35] 王亚丽,张莉,刘宏,等.改良早期预警评分识别病情临床应用现状[J].护理管理杂志,2017,17(5):359-361.
[36] 赵明,何锦华,金珊,等.感染可能性评分对输尿管软镜术后尿源性脓毒血症的筛查预测效果分析[J].中华医院感染学杂志,2018,28(24):3823-3826.DOI:10.11816/cn.ni.2018-173966.
[37] CHRISTINE K.LVAD infection during bridge-to-transplant,unique aspects of treatment and prevention[J].Current Opinion in Infectious Diseases,2018,23(4):400-406.DOI:10.1097/MOT.0000000000000548.
[38] 邱建丽,李庆印.能级管理在心脏移植病房的应用与效果[J].护理管理杂志,2012,12(4):296-297.
[39] 李文莉,孙玉荣,崔颖颖,等.一例左心室辅助患者心脏移植术后的护理[J].天津护理,2018,26(3):364-366.DOI:10.3969/j.issn.1006-9143.2018.03.043.
[40] MILLER L W,ROGERS J G.Evolution of left ventricular assist device therapy for advanced heart failure:a review[J].Joumal of the American Medical Association Cardiology,2018,3(7):650-658.DOI:10.1001/jamacardio.2018.0522.