Stanford A型主动脉夹层患者术后血流感染病原菌分布及其影响因素的Logistic回归分析

摘要 目的：分析Stanford A型主动脉夹层患者术后血流感染病原菌分布及其影响因素。方法：选取2020年6月-2023年1月新疆医科大学第一附属医院收治的102例Stanford A型主动脉夹层患者为研究对象。患者均接受手术治疗，统计术后血流感染的发生率、病原菌分布情况。根据患者术后血流感染的发生情况将患者分为感染组（n=17）和未感染组（n=85）。收集患者的临床资料，以单因素和多因素Logistic回归分析Stanford A型主动脉夹层患者术后血流感染的危险因素。结果：102例Stanford A型主动脉夹层患者术后出现血流感染17例，感染发生率为16.67%。17例血流感染患者分离病原菌45株，其中革兰氏阴性菌29株（64.44%）、革兰氏阳性菌13株（28.89%）、真菌3株（6.67%）。感染组患者的年龄、糖尿病史、抗生素疗程、手术时长、植入人工瓣膜比例、二次气管插管比例、机械通气比例、深静脉置管时长均高于未感染组（P<0.05）。多因素Logistic回归分析发现，高龄、二次气管插管、机械通气、深静脉置管时间长、手术时长、植入人工瓣膜比例高是患者术后血流感染的独立危险因素（P<0.05）。结论：Stanford A型主动脉夹层患者术后有较高的血流感染发生率，且主要感染致病菌以革兰氏阴性菌为主，其中高龄、二次气管插管、机械通气、深静脉置管时间长、手术时长、植入人工瓣膜比例高是患者术后血流感染的危险因素。

Pathogen Bacteria Distribution and Logistic Regression Analysis of Influencing Factors in Postoperative Blood Flow Infections in Patients with Stanford Type A Aortic Dissection

ABSTRACT Objective: To analyze the pathogen bacteria distribution and influencing factors of postoperative blood flow infection pathogens in patients with Stanford type A aortic dissection. Methods: 102 patients with Stanford type A aortic dissection admitted to The First Affiliated Hospital of Xinjiang Medical University from June 2020 to January 2023 were selected as the study subjects. All patients received surgical treatment, and the incidence of postoperative bloodstream infections and pathogen bacteria distribution were analyzed. Patients were divided into infected group (n=17) and uninfected group (n=85) based on the incidence of postoperative bloodstream infections. Collected clinical data from patients, and univariate and multivariate logistic regression to were used to analyze the risk factors for postoperative bloodstream infection in Stanford type A aortic dissection patients. Results: 102 patients with Stanford type A aortic dissection, 17 experienced postoperative bloodstream infections, with an infection rate of 16.67%.45 strains of pathogens were isolated from 17 patients with bloodstream infections, including 29 strains of Gram negative bacteria (64.44%), 13 strains of Gram positive bacteria (28.89%), and 3 strains of fungi (6.67%). The age, diabetes history, antibiotic treatment course, surgical duration, proportion of implantation of artificial valves, proportion of secondary tracheal intubation, proportion of mechanical ventilation, and duration of deep vein catheterization in the infected group were all higher than those in the uninfected group(P<0.05). Multivariate logistic regression analysis found that advanced age, second endotracheal intubation, mechanical ventilation, long time of deep vein catheterization, long surgical duration, and high proportion of implantation of artificial valves were independent risk factors for postoperative blood flow infection. Conclusion: The patients with Stanford A aortic dissection have a high incidence of blood flow infection after surgery, and the main pathogens of infection are Gram negative bacteria. The risk factors of blood flow infection after surgery are the advanced age, secondary tracheal intubation, mechanical ventilation, long time of deep vein catheterization, long surgical duration, and high proportion of implantation of artificial valves.