A型主动脉夹层手术后医院感染分析

Nosocomial infection after Type A aortic dissection surgery

目的探讨Stanford A型主动脉夹层手术后的医院感染特点和相关危险因素分析。方法回顾性收集、分析医院2009年2月-2010年10月A型主动脉夹层手术后患者的医院感染资料。结果 A型主动脉夹层手术252例,年龄(47.31±10.63)岁,男193例,女59例;医院感染32例,感染率12.7%;分离病原菌76株,革兰阴性菌49株,占64.5%,革兰阳性菌18株,占23.7%,真菌9株,占11.8%;感染组患者院内死亡9例,死亡率28.1%,非感染组院内死亡7例,死亡率3.2%,差异有统计学意义(P<0.01);多元回归分析显示,术后气管切开、急性肾衰竭床旁血滤和术后脑卒中是导致医院感染的独立危险因素。结论医院感染是A型主动脉夹层术后患者院内死亡的危险因素之一,术后气管切开,急性肾衰竭床旁血滤和术后脑卒中是增加医院感染的独立危险因素。

OBJECTIVE To analyze nosocomial infection condition and determine risk factors after type A Aortic Dissection Surgery.METHODS Clinical data of the patients who underwent type A aortic dissection surgery from Feb 2009 to Oct 2010 were collected.RESULTS The average age was（47.31±10.63） years;193 patients（76.6%） were male.Incidence of nosocomial infection was 12.7% in all 252 cases.A total of 76 strains were isolated in which gram negative bacteria accounted for 64.5%,gram positive bacteria for 23.7% and fungi for 11.8%.The hospital mortality was much higher among patients with nosocomial infection than in patients without nosocomial infection（28.1% vs 3.2%,P〈0.001）.Logistic regression analysis indicated postoperative tracheostomy,dialysis-dependent renal failure and stoke were the risk factors for nosocomial infection.CONCLUSION The nosocomial infection is one of the risk factors for in hospital mortality in patients after type A aortic dissection surgery.Postoperative tracheostomy,dialysis-dependent renal failure and stroke are the independent risk factors for nosocomial infection.