摘要
目的探讨降钙素原(PCT)对急性Stanford A型主动脉夹层患者术后感染的诊断价值。方法回顾性分析2017年6月至2019年12月中国医学科学院阜外医院深圳医院收治的急性Stanford A型主动脉夹层接受外科手术治疗的患者104例,男88例,女16例,年龄≥18岁。根据术后是否发生感染将患者分为两组:感染组(n=69)和非感染组(n=35)。记录两组术前一般资料及围术期情况,绘制受试者工作特征(ROC)曲线分析各炎症指标对诊断术后感染的曲线下面积(AUC)、最佳界值及对应的敏感性和特异性。结果与非感染组比较,感染组术中CPB时间、深低温停循环时间及主动脉阻断时间明显延长(P<0.05),术后APACHEⅡ评分及SOFA评分明显升高(P<0.01),术后机械通气时间、抗生素应用时间、ICU住院时间及总住院时间明显延长(P<0.01),术后急性肺损伤、急性肾损伤、连续肾脏替代治疗、全身炎症反应综合征、谵妄和肝功能不全发生率明显升高(P<0.01),围术期WBC、PCT浓度及体温明显升高(P<0.05)。两组围术期IL-6、超敏C-反应蛋白(hs-CRP)浓度差异无统计学意义。术后1、3、5 d WBC诊断术后感染的曲线下面积(AUC)分别为0.681、0.676、0.653,界值分别为9.505×10^9/L、13.285×10^9/L、13.390×10^9/L。术后1、3、5 d PCT诊断术后感染的AUC分别为0.862、0.876、0.863,界值分别为3.705、1.620、0.561 ng/ml,诊断效能高于WBC。结论与传统炎症指标比较,PCT对急性Stanford A型主动脉夹层患者术后感染有较好的诊断价值。
Objective To investigatethe diagnostic value of procalcitonin on postoperative infection in patients with acute Stanford type A aortic dissection.Methods A total of 104 patients with acute Stanford type A aortic dissection who underwent surgery in Fuwai Hospital Chinese Academy of Medical Sciences,Shenzhen from June 2017 to December 2019 were selected,88 males and 16 females,aged≥18 years.According to whether postoperative infection occurred,the patients were divided into the infection group(n=69)and the non-infection group(n=35).The preoperative data of the two groups were compared,and the receiver operating characteristic(ROC)curve analysis was used to evaluate the diagnostic value of inflammatory markers for postoperative infection.Results Compared with the non-infection group,the cardiopulmonary bypass time,deep hypothermic circulatory arrest time,and aortic cross clamp time in the infection group were significantly longer(P<0.05),postoperative APACHEⅡscores and SOFA scores in the infection group were significantly increased(P<0.01),postoperative mechanical ventilation time,antibiotic application time,ICU hospitalization time,and total hospitalization time in the infection group were significantly prolonged(P<0.01),The incidence of postoperative acute lung injury,acute kidney injury,continuous renal replacement therapy,systemic inflammatory response syndrome,delirium and liver dysfunction in the infection group were significantly increased(P<0.01).The concentration of WBC and PCT,and body temperature of the infection group were significantly higher than that of the non-infection group(P<0.05).There was no significant difference in IL-6 and high-sensitivity C-reactive protein(hs-CRP)during the perioperative period between the two groups.The area under curve(AUC)of WBC for diagnosis of postoperative infections 1,3 and 5 days after surgery were 0.681,0.676,and 0.653,with the critical values of 9.505×10^9/L,13.285×10^9/L,and 13.390×10^9/L,respectively.The AUC of PCT for diagnosis of postoperative infection
作者
白松杰
曾冰
黄志勇
BAI Songjie;ZENG Bing;HUANG Zhiyong(Department of Anesthesiology,Fuwai Hospital Chinese Academy of Medical Sciences,Shenzhen 518000,China)
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2021年第1期41-45,共5页
Journal of Clinical Anesthesiology
基金
深圳市科创委知识创新计划基础研究项目(JCYJ20170307161610240)。
