腹腔镜全子宫切除术后血栓前状态分子标志物与医院感染的关系  

Relationship between prethrombotic state molecular markers and nosocomial infection after laparoscopic total hysterectomy

作　　者：厉霞玲[1] 戎飞玲 何芳[1] 卞静静 周敏[1] LI Xia-ling;RONG Fei-ling;HE Fang;BIAN Jing-jing;ZHOU Min(Nanjing Hospital of Integrated Traditional Chinese and Western Medicine,Nanjing University of Chinese Medicine,Nanjing,Jiangsu 210014,China)

机构地区：[1]南京中医药大学附属南京市中西医结合医院妇产科,江苏南京210014

出　　处：《中华医院感染学杂志》2022年第15期2353-2357,共5页Chinese Journal of Nosocomiology

基　　金：江苏省科研基金资助项目(Q201924510)。

摘　　要：目的分析腹腔镜全子宫切除术患者术后血浆血栓前状态指标变化及与医院感染的关系。方法选取南京市中西医结合医院2018年12月-2020年12月腹腔镜全子宫切除术患者100例,按是否发生医院感染分为感染组、未感染组,比较其术后48 h内血栓前状态分子标志物、康复情况、炎症因子,后将医院感染者分为革兰阳性菌组、革兰阴性菌组,比较其上述各指标,并探讨其对医院感染的预测价值。结果20例在术后48 h内出现医院感染;术后24、48 h感染组血浆D-D、FIB、FDP及CRP、PCT、IL-6先升高后下降,而APTT、PT呈先缩短后延长(P<0.05),感染组术后24 h血浆D-D、FIB、FDP及CRP、PCT、IL-6均高于未感染组,感染组APTT、PT较未感染组缩短(P<0.05);感染组术后出血时间、住院时间较未感染组延长(P<0.05),均未出现静脉血栓;革兰阴性菌组术后24 h血浆D-D、FDP、CRP、IL-6高于革兰阳性菌组(P<0.05);术后24 h APTT、PT、D-D、FIB、FDP及CRP、PCT、IL-6预测腹腔镜全子宫切除术患者术后医院感染ROC曲线下面积分别为0.732、0.670、0.750、0.742、0.661、0.746、0.618、0.720,以D-D、APTT、FIB及CRP联合预测的曲线下面积最大,为0.887(P<0.05)。结论腹腔镜全子宫切除术后血栓前状态分子标志物在术后24 h内发生明显变化,且可能与炎症因子共同作用,导致医院感染。OBJECTIVE To analyze the relationship between prethrombotic state indicators and nosocomial infection after laparoscopic total hysterectomy.METHODS This study included 100 patients who underwent laparoscopic total hysterectomy in Nanjing Hospital of Integrated Traditional Chinese and Western Medicine from Dec 2018 to Dec 2020.The patients were divided into the infected group and uninfected group according to whether nosocomial infection occurred.The prethrombotic state indicators,recovery and inflammatory factors within 48 h after operation were compared between the groups.Patients in the infected group were divided into the Gram-positive bacteria group and Gram-negative bacteria group.The above-mentioned indicators were compared between the groups,and their predictive value for hospital infection was discussed.RESULTS 20 patients developed hospital infection within 48 h after operation.At 24 h and 48 h after operation,plasma D-D,FIB,FDP,CRP,PCT,and IL-6 levels in the infected group increased firstly and then decreased,while APTT and PT was shortened firstly and then was prolonged significantly(P<0.05).Plasma D-D,FIB,FDP,CRP,PCT,and IL-6 levels in the infected group were significantly higher than those in the uninfected group at 24 h after operation.The APTT and PT were significantly shorter than those in the uninfected group(P<0.05).The postoperative bleeding time and hospital stay in the infected group were significantly longer than those in the uninfected group(P<0.05).No venous thrombosis was observed in either group.Plasma D-D,FDP,CRP,and IL-6 levels in the Gram-negative bacteria group were significantly higher than those in the Gram-positive bacteria group at 24 h after operation(P<0.05).The area under the ROC curve values of APTT,PT,D-D,FIB,FDP,CRP,PCT,and IL-6 at 24 h after operation for predicting nosocomial infection after laparoscopic hysterectomy were 0.732,0.670,0.750,0.742,0.661,0.746,0.618,0.720,respectively.The area under the curve of joint prediction of DD,APTT,FIB and CRP was the largest(0.887)(

关 键 词：腹腔镜全子宫切除术 血栓前状态 分子标志物 术后感染 

分 类 号：R619[医药卫生—外科学]