Stanford A型主动脉夹层术后感染病原学及危险因素分析

Pathogenic characteristic and risk factors of postoperative infection in Stanford type A aortic dissection

目的对Stanford A型主动脉夹层(type A aortic dissection,TAAD)术后感染的病原学及危险因素进行调查分析。方法对2019年1月—2020年12月间河南省胸科医院接受TAAD手术的患者578例病例进行病例对照分析,探索患者感染的病原学分布和危险因素。结果共调查578例TAAD患者,共发生52例次术后感染,感染例次率8.99%。感染病原体以G-菌为主,排名前三位的分别是肺炎克雷伯菌、鲍曼不动杆菌和铜绿假单胞菌。Stanford A型主动脉夹层术后感染危险因素单因素分析中手术时间、有创呼吸机使用时间、血小板治疗量、深静脉置管时间等7个指标比较差异有统计学意义(P<0.05);有创呼吸机使用时间、体外循环时间、深静脉置管时间、抗生素使用时间与术后感染率呈现正相关(P<0.05);血小板治疗量、术前NT-proBNP数值与术后感染率呈现负相关(P<0.05)。结论TAAD术后感染以G-为主,应针对其感染的危险因素有针对性采取防控措施。

Objective To investigate and analyze the pathogenic characteristic and risk factors of postoperative infection of Stanford type A aortic dissection(TAAD).Methods A case-control study was carried out in 578 patients who underwent TAAD surgery in Henan Provincial Chest Hospital from January 2019 to December 2020 to explore the pathogen distribution and risk factors of infection.Results Among 578 patients with TAAD,52 cases of postoperative infection occurred.The overall infection rate was 8.99%.The main pathogen of infection G-bactera Klebsiella pneumoniae,Acinetobacter baumannii and Pseudomonas aeruginosa were the most common pathogens.In univariate analysis,the time of operation,the time of using invasive ventilator,the amount of platelet therapy,and the time of deep vein catheterization were significantly different in Stanford Type A aortic dissection patients with postoperative infection(P<0.05);The time of using invasive ventilator,the time of extracorporeal circulation and the time of deep vein indwelling catheter,the use time of antibiotics were positively correlated with the postoperative infection rate(P<0.05);There was a negative correlation between the amount of platelet treatment and the value of NT proBNP before operation and the postoperative infection rate(P<0.05).Conclusion The main postoperative infection of TAAD was G-bacteria,and the prevention and control measures should be taken according to the risk factors of infection.