临床儿科杂志 ›› 2022, Vol. 40 ›› Issue (1): 51-.doi: 10.12372/jcp.2022.21e0492

• 综合报道 • 上一篇    下一篇

儿童先天性心脏病术后医院感染风险因素分析

罗润娇, 杜欣为, 龚霄雷, 陈一玮, 郝泽东, 王伟   

  1. 上海交通大学医学院附属上海儿童医学中心心胸外科(上海 200127 )
  • 出版日期:2022-01-15 发布日期:2022-01-11
  • 通讯作者: 王伟 电子信箱:wangwei@scmc.com.cn
  • 基金资助:
    国家自然科学基金资助项目(No.82070430)

Analysis of risk factors of nosocomial infection in children with congenital heart disease after surgery

y LUO Runjiao, DU Xinwei, GONG Xiaolei, CHEN Yiwei, HAO Zedong, WANG Wei   

  1. Department of Thoracic and Cardiovascular Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
  • Online:2022-01-15 Published:2022-01-11

摘要: 目的 探讨先天性心脏病(CHD)患儿手术前中性粒细胞淋巴细胞比值(NLR)及其他因素与术后医院 感染的关系。方法 收集2006至2017年行心脏手术患儿11 937例,根据NLR随年龄增长分布的变化拐点及发生医 院感染与否将患儿分为<224天感染组和未感染组及≥224天感染组和未感染组,分析其术后医院感染的风险因素。 结果 11 937例患儿中男6 746例、女5 191例,中位年龄316 . 0(175 . 0 ~ 838 . 0)d。发生医院感染1 325例(占11 . 1 %), 其中<224天830例(19.15%)、≥224天495例(6.51%)。<224天患儿的医院感染率高于≥224天患儿,差异有统计 学意义(P<224天患儿术后发生医院感染的独立风险因素(P<0.05);而年龄大、淋巴细胞白细胞比值(LWR)异常是<0.05)。心脏手术史、术前有感染、STS风险评级≥3、ALT异常、AST异 常是≥224天患儿术后发生医院感染的独立风险因素(P<0.05)。NLR预测<224天患儿术后发生医院感染的曲线下面积(AUC)为 0.594(95%CI:0 . 572 ~ 0 . 617);当NLR>0.542时,其诊断医院感染的灵敏度为41 . 8 %、特异度为73 . 6 %。结论 近 年CHD患儿术后感染率有所降低。年龄小、BMI-Z评分低、术前感染、手术复杂、手术时间长和NLR升高是CHD患儿 术后感染的风险因素。

关键词: 血中性粒细胞淋巴细胞比值; 医院感染; 心脏手术; 儿童

Abstract: : Objective To investigate the relationship between preoperative neutrophil lymphocyte ratio (NLR) and other factors and postoperative nosocomial infection in children with congenital heart disease (CHD). Methods A total of 11937 children who underwent cardiac surgery from 2006 to 2017 were collected. According to the inflection point of NLR distribution with age and whether nosocomial infection occurred, the children with the age of score and abnormal LWR were independent protective factors for postoperative nosocomial infection in children≥224 days (P<0 . 05 ). The area under the curve (AUC) of NLR for predicting nosocomial infection in children <224 days was 0 . 594 ( 95 %CI: 0 . 572 ~ 0 . 617 ). When NLR>0 . 542 , its sensitivity and specificity for diagnosing nosocomial infection were 41 . 8 % and 73 . 6 %. Conclusion The postoperative infection rate of CHD children has decreased in recent years. Younger age, low BMI-Z score, preoperative infection, complex surgery, long operation time and increased NLR are the risk factors for postoperative infection in CHD children.

Key words: neutrophil lymphocyte ratio; nosocomial infection; cardiac surgery; child