黑龙江地区Stanford A型主动脉夹层撕裂患者术后血流感染的危险因素分析

Analysis of risk factors of blood stream infection in patients with Stanford type A aortic dissection tear in Heilongjiang province

目的研究黑龙江地区Stanford A型主动脉夹层(Stanford type A aortic dissection,TAAD)撕裂患者术后血流感染的相关危险因素。方法回顾性分析哈尔滨医科大学附属第四医院2018年1月至2019年8月收治的TAAD撕裂患者240例,检测患者术后血液标本,根据是否出现血流感染将纳入患者分为阳性组(49例)和阴性组(191例)。详细记录患者的临床资料,采用多因素Logistic回归分析探讨TAAD撕裂患者术后血流感染的危险因素。结果240例TAAD撕裂患者术后发生血流感染49例,感染率为20.42%,其中革兰氏阳性菌感染32例,占比65.31%,革兰氏阴性菌感染15例,占比30.61%,真菌感染2例,占比4.08%。多因素Logistic回归分析显示高龄、二次气管插管、不合理应用抗生素、心包纵隔管保留时间及深静脉置管时间过长均为影响TAAD撕裂患者术后血流感染的危险因素(均P<0.05)。结论TAAD撕裂患者术后血流感染发生率较高,应加强临床监护,规范无菌操作,以降低血流感染的发生风险。

Objective To study the risk factors of blood stream infection in patients with Stanford type A aortic dissection(TAAD)tear in Heilongjiang province.Method 240 patients with TAAD tear admitted to the Fourth Affiliated Hospital of Harbin Medical University from January 2018 to August 2019 were retrospectively analyzed.The blood samples of TAAD patients were detected in vitro.According to whether the blood stream infection occured,they were divided into positive group(n=49)and negative group(n=191).The clinical data of patients were recorded in detail,and multivariate Logistic regression analysis was used to investigate the risk factors of postoperative blood stream infection in patients with TAAD tear.Result There were 49 cases of blood stream infection in 240 patients with TAAD tear,the infection rate was 20.42%,including 32 cases of Gram-positive bacteria(65.31%),15 cases of Gram-negative bacteria(30.61%)and 2 cases of fungus(4.08%).Multivariate Logistic regression analysis showed that elderly age,secondary tracheal intubation,unreasonable use of antibiotics,long retention time of pericardial and mediastinal tube and deep vein catheterization were were risk factors for postoperative blood stream infection in patients with TAAD tear.Conclusion The incidence of blood stream infection is high in patients with TAAD tear.We should strengthen clinical monitoring and standardize aseptic operation to reduce the risk of blood stream infection.