| 张洪叶,张 彰,梁百闯,吴 冰,马思星.Stanford A型主动脉夹层孙氏手术患者术后血流感染的影响因素及术前PCT、IL-6、D-D的预测价值研究[J].,2023,(1):122-126 |
| Stanford A型主动脉夹层孙氏手术患者术后血流感染的影响因素及术前PCT、IL-6、D-D的预测价值研究 |
| Influencing Factors of Postoperative Bloodstream Infection in Patients with Stanford Type A Aortic Dissection and the Predictive Value Study of Preoperative PCT, IL-6 and D-D |
| 投稿时间：2022-04-30 修订日期：2022-05-24 |
| DOI：10.13241/j.cnki.pmb.2023.01.024 |
| 中文关键词: 主动脉夹层 Stanford A型 孙氏手术 术后血流感染 降钙素原 白细胞介素-6 D-二聚体 |
| 英文关键词: Aortic dissection Stanford type A Sun's operation Postoperative bloodstream infection PCT IL-6 D-D |
| 基金项目:贵州省卫生健康委科学技术基金项目（gzwjkj2018-1-019） |
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| 中文摘要: |
| 摘要 目的：分析Stanford A型主动脉夹层（AD）孙氏手术患者术后血流感染（BSI）的影响因素，并探讨术前血清降钙素原（PCT）、白细胞介素-6（IL-6）、D-二聚体（D-D）对术后发生BSI的预测价值。方法：选取2019年1月～2022年1月贵州医科大学附属医院收治的236例接受孙氏手术的Stanford A型AD患者，根据术后是否BSI分为BSI组和非BSI组。收集患者基础资料和实验室指标，采用多因素Logistic回归分析Stanford A型AD孙氏手术患者术后发生BSI的影响因素，采用受试者工作特征（ROC）曲线分析血清PCT、IL-6、D-D水平对Stanford A型AD孙氏手术患者术后发生BSI的预测价值。结果：BSI组年龄≥60岁、糖尿病史、机械通气、气管切开、人工瓣膜植入比例和术后24 h引流量、血清C反应蛋白、PCT、IL-6、D-D水平高于非BSI组，手术时间、心包纵隔管保留时间长于非BSI组（P＜0.05）。多因素Logistic回归分析显示，年龄≥60岁、糖尿病史、机械通气、气管切开、术后24 h引流量上升，血清PCT、IL-6、D-D水平上升为Stanford A型AD孙氏手术患者术后发生BSI的危险因素（P＜0.05）。ROC曲线分析显示，血清PCT、IL-6、D-D三项联合预测的Stanford A型AD孙氏手术患者术后发生BSI的曲线下面积大于单独预测。结论：年龄、糖尿病史、机械通气、气管切开、术后24 h引流量、血清PCT、IL-6、D-D水平是Stanford A型AD孙氏手术患者术后发生BSI的影响因素，术前血清PCT、IL-6、D-D水平可作为Stanford A型AD孙氏手术患者术后发生BSI的辅助预测指标。 |
| 英文摘要: |
| ABSTRACT Objective: To analyze the influencing factors of postoperative bloodstream infection (BSI) in patients with Stanford type A aortic dissection (AD), and to explore the predictive value of preoperative serum procalcitonin (PCT), interleukin-6 (IL-6), D-Dimer (D-D) for postoperative BSI occurred. Methods: 236 patients with Stanford type A AD who underwent sun's operation in Affiliated Hospital of Guizhou Medical University from January 2019 to January 2022 were selected,and they were divided into BSI group and non BSI group according to whether they had BSI after operation. The basic data and laboratory indexes of patients were collected. The influencing factors of postoperative BSI in patients with Stanford type A AD sun's operation were analyzed by multivariate Logistic regression. The predictive value of serum PCT, IL-6 and D-D levels on postoperative BSI in patients with Stanford type A AD sun's operation was analyzed by receiver operating characteristic (ROC) curve. Results: The age ≥60 years, diabetes history, mechanical ventilation, tracheotomy, prosthetic valve implantation ratio, 24 h postoperative drainage volume, serum C-reactive protein, PCT, IL-6 and D-D levels in BSI group were higher than those in non BSI group, and the operation time and pericardial mediastinal tube retention time in BSI group were longer than those in non BSI group (P＜0.05). Multivariable Logistic regression analysis showed that age ≥60 years, diabetes history, mechanical ventilation, tracheotomy, increase of 24 h postoperative drainage volume, and increase of serum PCT, IL-6 and D-D levels were the risk factors for BSI in patients with Stanford type A AD after sun's operation (P＜0.05). ROC curve analysis showed that the area under curve of BSI in patients with Stanford type A AD after sun's operation predicted jointly by serum PCT, IL-6 and D-D was greater than that predicted alone. Conclusion: Age, diabetes history, mechanical ventilation, tracheotomy, 24 h postoperative drainage volume, serum PCT, IL-6 and D-D levels are the influencing factors of postoperative BSI in patients with Stanford type A AD. preoperative serum PCT, IL-6 and D-D levels can be used as auxiliary predictors of postoperative BSI in patients with Stanford type A AD. |
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