心脏外科手术中自体血细菌培养阳性危险因素分析的一项单中心病例对照研究  

Analysis of risk factors for bacterial culture positivity in autologous blood during cardiac surgery:a single center case-control study

作　　者：周晔农 王立伟 杨晨 杨秀玲 陈涛 赵荣 刘金成 杨静 张洁 王馨怡 张超 王娇姣 金振晓 Zhou Yenong;Wang Liwei;Yang Chen;Yang Xiuling;Chen Tao;Zhao Rong;Liu Jinchen;Yang Jing;Zhang Jie;Wang Xinyi;Zhang Chao;Wang Jiaojiao;Jin Zhenxiao(Department of Cardiovascular Surgery,Xijing Hospital,Air Force Medical University,Shaan'xi Xi'an 710032,China)

机构地区：[1]空军军医大学第一附属医院心血管外科,西安710032

出　　处：《中国体外循环杂志》2022年第5期290-294,311,共6页Chinese Journal of Extracorporeal Circulation

基　　金：陕西省重点研发计划(2020SF-250,2019ZDLSF01-01-02);国科金重点项目(51837011)。

摘　　要：目的 本研究旨在明确心脏手术中自体血细菌培养阳性的影响因素及对患者短期预后的影响。方法 前瞻性收集西京医院2021年9月至2021年12月行心脏手术需使用术中自体血回输技术的患者资料,对自体血及术后第1天、第3天采集的患者血液进行细菌培养。根据自体血的细菌培养是否阳性分为有菌组与无菌组。结果 有菌组培养出的细菌大部分为表皮葡萄球菌,患者术后第3天血培养有菌组阳性率显著大于无菌组,但每例患者术后血培养菌的种类与自体血中菌的种类不一致。有菌组与无菌组的ICU停留时间、住院时间、异体血液输注、预后及转归等并没有显著差异;女性、吸烟、心功能差及手术室空气中0.5μm孔径的尘埃粒子数高是自体血发生细菌培养阳性的危险因素。结论 有菌组自体血检测出的细菌占比最高的是表皮葡萄球菌,具有潜在的感染风险,而自体血细菌培养阳性与患者的性别、吸烟、心功能及手术室空气质量显著相关。Objective To explore the influencing factors of bacterial culture positivity in autologous blood during cardiac surgery and its impact on the short-term prognosis of patients.Methods The clinical information of patients who needed intraoperative cell salvage(ICS) technique during cardiac surgery in Xijing Hospital from September 2021 to December 2021 was prospectively collected.The autologous blood and the blood collected on the 1^(st) and 3^(rd) day after operation were cultured.According to whether the bacterial culture of autologous blood was positive or not,patients were divided into bacterial group and sterile group.Results Most of the bacteria cultured in the bacterial group was Staphylococcus epidermidis.The positive rate of blood culture in bacterial group on the 3^(rd) day after operation was significantly higher than that of the sterile group but the types of bacteria on the 1^(st) and 3^(rd) were inconsistent with those in the autologous blood.There was no significant difference in ICU stay,hospital stay,allogeneic blood transfusion,prognosis and outcomes between the bacterial group and the sterile group.The study found that female,smoking history,poorer cardiac function and high number of dust particles with 0.5 μm pore size in the operating room were risk factors for bacterial culture positivity in autologous blood.Conclusion Most of the bacteria grown from the bacterial group was Staphylococcus epidermidis which had a potential risk of infection.And the bacterial culture positivity in autologous blood is significantly related to the gender,smoking history,poorer cardiac function of patients and higher number of dust particles in the air of the operating room.

关 键 词：心脏外科手术 心肺转流 体外循环 术中自体血回输 表皮葡萄球菌 手术室 空气质量 院内感染 

分 类 号：R654.2[医药卫生—外科学]