Stanford A型主动脉夹层术后血流感染危险因素及感染性标志物早期预测价值

Risk factors for bloodstream infection after Stanford A aortic dissection surgery and early predictive value of infectious markers

目的探讨Stanford A型主动脉夹层术后血流感染(BSI)病原菌分布、危险因素及感染性标志物对BSI的早期预测价值。方法选取2014年1月-2019年6月南阳医专第一附属医院收治的Stanford A型主动脉夹层患者126例,根据患者术后是否出现BSI将其分为感染组与非感染组,分析病原菌特点,比较两组患者临床资料并行术后BSI危险因素分析,采用受试者工作特征曲线(ROC)评价血清降钙素原(PCT)、C-反应蛋白(CRP)、白细胞计数(WBC)、中性粒细胞淋巴细胞比率(NLR)对BSI的早期预测价值。结果126例Stanford A型主动脉夹层患者术后19例出现BSI,术后BSI发生率为15.08%;分离感染病原菌26株,革兰阴性菌17株,革兰阳性菌8株,真菌1株;多因素Logistic回归分析显示年龄≥60岁、机械通气、静脉置管时间≥7 d、气管切开、住院时间≥10 d是术后BSI的影响因素(P<0.05),ROC曲线分析显示PCT、CRP、WBC、NLR的曲线下面积(AUC)比较无统计学差异,截断值分别为9.720 ng/ml、12.665 mg/L、9.865×10^(9)/L、7.930。结论术后BSI病原菌感染以革兰阴性菌为主,气管切开、机械通气、延长静脉置管时间等会增加Stanford A型主动脉夹层术后BSI风险,PCT、CRP、WBC、NLR对术后BSI具有较好的早期预测效能。

OBJECTIVE To explore the pathogenic bacteria distribution and risk factors for bloodstream infection(BSI)after Stanford A aortic dissection surgery and early predictive value of infectious markers for BSI.METHODS A total of 126 patients with Stanford A aortic dissection admitted to the First Affiliated Hospital of Nanyang Medical College between Jan 2014 and Jun 2019 were enrolled.According to presence or absence of postoperative BSI,they were divided into the infection group and non-infection group.The characteristics of pathogens distribution were analyzed.The clinical data were compared between the two groups.The risk factors for BSI after Stanford A aortic dissection surgery were analyzed.The early predictive value of serum procalcitonin(PCT),C-reactive protein(CRP),white blood cell count(WBC)and neutrophil-lymphocyte ratio(NLR)for BSI was evaluated by receiver operating characteristic(ROC)curves.RESULTS Of the 126 patients with Stanford A aortic dissection,19 cases(15.08%)were postoperative BSI,with the incidence of 15.08%.Twenty-six strains of infectious pathogens were isolated,including 17 strains of Gram-negative bacteria,8 strains of Gram-positive bacteria and 1 strain of fungus.Multivariate Logistic regression analysis showed that age≥60,not younger than 60 years old),mechanical ventilation,venous catheterization time≥7 d,tracheotomy and hospitalization time≥10 d were independent risk factors for postoperative BSI(P<0.05).ROC curve analysis showed that there were no significantly difference of area under the curve(AUC)among PCT,CRP,WBC and NLR,with the cut-off values of 9.720 ng/ml,12.665 mg/L,9.865(×10^(9)/L)and 7.930,respectively.CONCLUSION The main postoperative BSI pathogens are Gram-negative bacteria.Elderly age,tracheotomy,mechanical ventilation,prolonging venous catheterization time and hospitalization time will increase BSI risk after Stanford A aortic dissection surgery.PCT,CRP,WBC and NLR are of good early predictive efficiency for postoperative BSI.