急性Stanford A型主动脉夹层患者术后感染的危险因素分析

目的 分析急性Stanford A型主动脉夹层患者术后感染的危险因素。 方法 分析2017年6月～2019年12月本院收治的急性Stanford A型主动脉夹层接受外科手术治疗的患者（n = 104），根据术后是否发生感染，将患者分为非感染组(n = 35)和感染组(n = 69)。 结果 与非感染组相比，感染组术前体温明显升高（P<0.05）；术中心肺转流（cardiopulmonary bypass，CPB）时间和主动脉阻断（aortic cross clamp，ACC）时间明显延长（P<0.01），深低温停循环（deep hypothermic circulatory arrest，DHCA）时间明显延长（P<0.05）；术后机械通气时间、重症监护室（intensive care unit，ICU）住院时间和总住院时间明显延长（P<0.01）；术后急性肺损伤、急性肾损伤和全身炎症反应综合征（systemic inflammatory response syndrome，SIRS）发生率明显增高（P<0.01）。多因素Logistic回归分析发现:ICU住院时间（OR = 1.503，95%CI:1.013～2.230，P<0.05）和SIRS（OR = 11.635，95%CI:1.515～89.336，P<0.05）是急性Stanford A型主动脉夹层患者术后感染的独立危险因素。分析受试者工作特征曲线发现ICU住院时间的临界值为7.5 d，曲线下面积为0.865（P<0.01）。 结论 术后感染将明显不利于急性Stanford A型主动脉夹层患者的临床预后。ICU住院时间>7.5 d及术后出现SIRS是术后感染发生的独立危险因素。

Risk factors of postoperative infection in patients with acute Stanford type A aortic dissection

AIM To explore the risk factors of postoperative infection in patients with acute Stanford type A aortic dissection. METHODS The clinical data of patients with acute Stanford type A aortic dissection who received surgical treatment in our hospital from June 2017 to December 2019 were analyzed retrospectively. According to whether infection occurred after surgery, the patients were divided into infection group (n = 69) and non-infection group (n = 35). The general conditions and perioperative data of the two groups were collected, and the risk factors of postoperative infection were analyzed using Logistic regression. RESULTS This study included 104 patients with acute Stanford type A aortic dissection, 69 in the infection group and 35 in the non infection group. Compared with those in non-infection group, the temperature in infection group increased significantly before surgery (P<0.05), the cardiopulmonary bypass time, aortic cross clamp time and deep hypothermic circulatory arrest time were significantly longer (P<0.05), mechanical ventilation time, ICU stay time and total hospitalization time increased significantly (P<0.01), and the incidence of postoperative acute lung injury, acute kidney injury and systemic inflammatory response syndrome (SIRS) increased significantly (P<0.01). Multivariate logistic regression analysis showed that ICU stay time (OR = 1.503, 95% CI: 1.013～2.230, P<0.05) and SIRS (OR = 11.635, 95% CI: 1.515～89.336, P<0.05) were independent risk factors for postoperative infection in patients with acute Stanford type A aortic dissections.ROC curve analysis showed that the critical length of ICU stay was 7.5 days and the area under the curve was 0.865 (P<0.01). CONCLUSION Postoperative infection will be significantly detrimental to the clinical prognosis of patients with acute Stanford type A aortic dissection. The length of stay in ICU >7.5 d and the postoperative SIRS were independent risk factors for postoperative infection.