体外循环心脏直视术后手术部位感染的危险因素分析及炎症指标表达水平

Risk factors for postoperative surgical site infection in patients undergoing intracardiac surgery under extracorporeal circulation and levels of inflammatory markers

目的探讨体外循环心脏术后手术部位感染(SSI)的危险因素及血中炎症指标水平。方法收集2015年5月-2017年1月本院成人体外循环心脏手术100例患者的临床资料。根据是否发生SSI分为SSI组、对照组,每组50例。统计两组患者术前心功能、其他病史、围术期等临床情况。检测血中降钙素原(PCT)水平,WBC计数,C-反应蛋白(CRP)水平。对临床数据数量化赋值后,进行SSI的单因素及多因素分析。比较两组术前、术后1天、术后3天的PCT、WBC、CRP水平。结果 SSI组体外循环时间、手术时间明显长于对照组,血液制品用量明显多于对照组,术后12h血糖平均值明显高于对照组,差异有统计学意义(P<0.05或P<0.01)。单因素分析结果显示,左室射血分数<50%、心功能NYHA≥Ⅲ级、糖尿病、慢性阻塞性肺疾病、体外循环时间≥90min、手术时间≥240min、切口皮下层连续缝合、二次开胸止血、血液制品用量>2.5L、术后高血糖(空腹血糖≥140mg/dL)、ICU时间≥72h与SSI发生有关(P<0.05)。Logistic多元回归分析显示,手术时间≥240min、切口皮下层连续缝合、术后高血糖为SSI发生的危险因素。SSI组术后1天、3天时炎性指标均明显高于对照组(P<0.05)。结论手术时间≥240min、切口皮下层连续缝合、术后高血糖为体外循环心脏直视术后SSI发生的独立危险因素。体外循环心脏直视术后SSI的患者血中PCT、WBC、CRP水平明显增高,可作为SSI的诊断参考。

OBJECTIVE To explore the risk factors for postoperative surgical site infection（SSI）in the patients undergoing intracardiac surgery under extracorporeal circulation and observe the levels of serum inflammatory markers.METHODS The clinical data were collected from 100 patients who received the intracardiac surgery under extracorporeal circulation in the hospital from May 2015 to Jan 2017.The enrolled patients were divided into the SSI group and the control group according to the status of SSI,with 50 cases in each group.The preoperative cardiac function,history of other diseases and perioperative condition were statistically analyzed,the levels of serumprocalcitonin（PCT）,WBC counts and C-reactive protein（CRP）were detected.The univariate analysis and multivariate analysis were performed for SSI after the clinical were processed for quantitative assignment.The levels of PCT,WBC and CRP were compared between the two groups of patients before the surgery and after the surgery for 1 and 3 days.RESULTS The extracorporeal circulation time and operation duration were significantly longer in the SSI group than in the control group,the dosage of blood products of the SSI group was significantly more than that of the control group,the postoperative 12-hour blood glucose level of the SSI group was significantly higher than that of the control group,and there were significant differences（P〈0.05 or P〈0.01）.The result of univariate analysis indicated that the incidence of SSI was associated with left ventricular ejection fraction less than50%,cardiac function NYHA no less than gradeⅢ,diabetes mellitus,chronic obstructive pulmonary disease,time of extracorporeal circulation no less than 90 min,operation duration no less than 240 min,continuous suture of incisional subcutaneous layer,secondary thoracotomy for hemostasis,dosage of blood products more than2.5 L,postoperative hyperglycemia（fasting blood glucose no less than 140 mg/dL）and ICU stay no less than 72 hours（P〈0.05）.The result of multivariate logistic regression analysis showed that the operation duration no less than 240 min,continuous suture of incisional subcutaneous layer and postoperative hyperglycemia were the risk factors for the SSI.The levels of inflammatory markers of the SSI group were significantly higher than those of the control group after the surgery for 1 and 3 days（P〈0.05）.CONCLUSIONS The operation duration no less than240 min,continuous suture of incisional subcutaneous layer and postoperative hyperglycemia are the independent risk factors for the SSI in the patients undergoing intracardiac surgery under extracorporeal circulation.The levels of serum PCT,WBC and CRP of the patients with postoperative SSI are significantly elevated,which can be used for diagnosis of SSI.