主动脉弓部置换术后监测血浆降钙素原对院内感染的诊断价值  

The diagnostic value of plasma procalcitonin in nosocomial infection after aortic arch surgery

作　　者：刘红[1] 郭宏伟[2] 张志娴 黎星 张海涛[1] 孙晓刚[2] Liu Hong;Guo Hongwei;Zhang Zhixian;Li Xing;Zhang Haitao;Sun Xiaogang(Department of Cardiac Surgery,State Key Laboratory of Cardiovascular Disease,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院心血管疾病国家重点实验室术后恢复中心,北京100037 [2]中国医学科学院北京协和医学院国家心血管病中心阜外医院心脏外科,北京100037 [3]中国医学科学院阜外医院深圳医院心外科ICU,深圳518000

出　　处：《中国体外循环杂志》2022年第4期221-225,共5页Chinese Journal of Extracorporeal Circulation

基　　金：国家心血管病中心阜外医院院所重点项目(2018-F02)。

摘　　要：目的探讨降钙素原(PCT)在行深低温停循环主动脉弓部手术患者术后发生院内感染的诊断价值。方法回顾性分析2020年1月1日至2020年12月31日132例深低温停循环下行主动脉弓部置换术患者的临床资料。记录术后6日连续监测的血浆PCT值,描记术后PCT的变化趋势,绘制受试者工作特征(ROC)曲线,探讨PCT对院内感染的诊断意义。结果术后发生院内感染12例(9.1%)。非感染患者的PCT水平术后1日(PCT1)最高,随后逐日下降,而发生感染患者的PCT在术后2~5日再次达到峰值。PCT1、PCT最大值(PCTmax)及PCT均值(PCTmean)对术后感染的ROC曲线都有显著性意义,PCT1曲线下面积(AUC)=0.738(95%CI:0.570~0.907,P=0.013),PCTmax(AUC)=0.866(95%CI:0.740~0.992,P=0.000),PCTmean(AUC)=0.841(95%CI:0.719~0.964,P=0.000)。PCT1、PCTmax和体外循环时间具有显著正相关性(Spearman相关系数分别为0.340和0.275,P=0.006,P=0.004)。结论PCT对深低温停循环主动脉弓部手术术后患者的感染有诊断价值,需要动态监测PCT的变化。Objective To investigate the diagnostic value of procalcitonin(PCT)in postoperative nosocomial infection in pa⁃tients undergoing aortic arch surgery.Methods From January 1,2020 to December 31,2020,the data of 132 patients undergoing aortic arch replacement with deep hypothermic circulation arrest were retrospectively analyzed.PCT was monitored continuously 6 days after operation,and patients with postoperative infection were recorded.The changing trend of PCT was recorded,and the ROC curve was drawn to explore the diagnostic significance of PCT for infection.Results 12 patients(9.1%)developed a nosocomial infection.The level of PCT was highest at 1 postoperative day in non-infected patients,and then decreased,while the level of PCT in infected patients reached the peak again at 2-5 postoperative days.The ROC curve of PCT1,PCTmax and PCTmean for postoperative infec⁃tion were significant.PCT1(AUC)=0.738(95%CI:0.570-0.907,P=0.013),PCTmax(AUC)=0.866(95%CI:0.740-0.992,P<0.001),PCTmean(AUC)=0.841(95%CI:0.719-0.964,P<0.001).There was a significant positive correlation between PCT1,PCTmax and cardiopulmonary bypass time(Spearman correlation coefficient was 0.340 and 0.275,P=0.006,P=0.004).Conclusion PCT has diagnostic value for postoperative infection in patients undergoing deep hypothermic circulation arrest aortic arch surgery.Changes in PCT need to be monitored dynamically.

关 键 词：降钙素原 主动脉手术 体外循环 深低温停循环 院内感染 

分 类 号：R654.2[医药卫生—外科学]