心脏瓣膜术后感染病原菌及其危险因素  

Pathogens and risk factors for postoperative infections in heart valve surgery patients

作　　者：李海勋 任恺 郝跃文 徐月亮 胡诗礼[1] 吴浪 向志涛 曾祥君 LI Hai-xun;REN Kai;HAO Yue-wen;XU Yue-liang;HU Shi-li;WU Lang;XIANG Zhi-tao;ZENG Xiang-jun(Zunyi First People's Hospital,Zunyi,Guizhou 563000,China;不详)

机构地区：[1]遵义市第一人民医院心脏血管外科,贵州遵义563000 [2]空军军医大学附属西京医院心脏血管外科,陕西西安710032 [3]西安市儿童医院放射科,陕西西安710032 [4]空军军医大学附属唐都医院胸心外科,陕西西安710038

出　　处：《中华医院感染学杂志》2024年第21期3276-3280,共5页Chinese Journal of Nosocomiology

基　　金：陕西省自然科学基础研究计划基金资助项目(2023-JC-YB-635)。

摘　　要：目的探讨心脏瓣膜术后感染病原菌及其危险因素。方法选取遵义市第一人民医院2019年1月-2023年12月82例心脏瓣膜术后感染患者为研究组,另根据倾向性匹配原则以1∶1比例选取同期医院82例心脏瓣膜术后未出现感染患者为对照组,分析研究组病原菌分布,检测并比较两组血清降钙素原(PCT)、微小核糖核酸(miR)-146a、miR-223水平,并分析三指标对心脏瓣膜术后感染的预测价值,分析心脏瓣膜术后感染危险因素。结果心脏瓣膜术后感染患者的感染部位主要为下呼吸道感染,病原菌中革兰阴性菌最多;研究组血清PCT、miR-146a、miR-223水平均高于对照组(P<0.05);研究组年龄≥60岁、术前心力衰竭、术前左室射血分数(LVEF)<50%、术后胸腔积液、术后低心排综合征占比均高于对照组(P<0.05);血清PCT、miR-146a、miR-223水平联合预测心脏瓣膜术后感染的曲线下面积(AUC)高于三指标单独预测(P<0.05);Logistic模型显示,年龄、术前心力衰竭、术前LVEF、术后胸腔积液、术后低心排综合征、血清miR-146a及miR-223是心脏瓣膜术患者术后感染的危险因素(P<0.05)。结论心脏瓣膜术患者术后感染多为下呼吸道感染,以革兰阴性菌感染为主,患者血清PCT、miR-146a、miR-223呈升高趋势,三指标联合对心脏瓣膜术后感染具有一定的预测价值。OBJECTIVE To explore the pathogens and risk factors for postoperative infections in the heart valve surgery patients.METHODS A total of 82 patients who underwent the heart valve surgery and had postoperative infection in the Zunyi First People′s Hospital from Jan.2019 to Dec.2023 were assigned as the study group,meanwhile,82 patients who underwent the heart valve surgery patients but did not have postoperative infection were chosen as the control group in a 1∶1 ratio based on propensity to matching principle.The distribution of pathogens isolated from the study group was analyzed,the levels of serum procalcitonin(PCT),microribonucleic acid(miR)-146a and miR-223 were compared between the two groups.The values of the three indexes in prediction of the postoperative infection were analyzed,and the risk factors for the postoperative infection in the heart valve surgery patients were observed.RESULTS The patients with lower respiratory tract infection were dominant among the heart valve surgery patients with postoperative infection.Gram-negatvie bacteria were the predominant pathogens.The levels of serum PCT,miR-146a and miR-223 of the study group were significantly higher than those of the control group(P<0.05).The proportions of patients with no less than 60 years of age,preoperative heart failure,preoperative left ventricular ejection fraction(LVEF)less than 50%,postoperative pleural effusion and postoperative low cardiac output syndrome were significantly higher in the study group than in the control group(P<0.05).The area under the curve(AUC)of the joint detection of serum PCT,miR-146a and miR-223 was significantly higher than that of the single detection in prediction of postoperative infection in the heart valve surgery patients(P<0.05).Logistic model showed that the age,preoperative heart failure,preoperative LVEF,postoperative pleural effusion,postoperative low cardiac output syndrome,serum miR-146a and miR-223 were the risk factors for the postoperative infection in the heart valve surgery patients(P<0.0

关 键 词：心脏瓣膜术 术后感染 病原菌 降钙素原 微小核糖核酸-146a 微小核糖核酸-223 危险因素 

分 类 号：R619.3[医药卫生—外科学]