食管癌根治术患者化疗期间肺部感染的影响因素及病原菌分析
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摘要
目的研究食管癌术后化疗患者发生肺部感染的危险因素及菌群分布特点。方法选取2015年1月-2017年1月在医院接受根治性手术后行化疗的79例食管癌患者。按照患者术后化疗是否存在肺部感染分为感染组和未感染组,比较两组患者年龄、性别、糖尿病史、高血压史、冠状动脉粥样硬化性心脏病(CAHD)、慢性阻塞性肺疾病(COPD)、吸烟史、手术时间、术前肺功能、术中出血量、病理分期等临床资料。结果 79例食管癌术后化疗患者,27例发生肺部感染患者,感染率31.18%。肺部感染组中年龄>60岁、糖尿病史、伴有COPD、吸烟史、手术时间>4h的患者多于未感染组(P<0.05)。多因素logistic回归分析显示,年龄>60岁、糖尿病史、伴有COPD、吸烟史、手术时间>4h是食管癌术后化疗患者肺部发生感染的独立危险因素(P<0.05)。27例肺部感染患者,共培养病原菌36株。以革兰阴性菌为主。结论高龄、糖尿病、COPD、吸烟史、较长的手术时间是影响食管癌术后化疗患者肺部发生感染的独立危险因素,肺部感染病原菌以革兰阴性菌为主。
OBJECTIVE To explore the risk factors for the pulmonary infection in the radical esophagectomy patients undergoing postoperative chemotherapy and analyze the distribution of pathogens.METHODS From Jan 2015 to Jan 2017,a total of 79 patients with esophageal cancer who received the chemotherapy after the radical esophagectomy were enrolled in the study and divided into the infection group and the non-infection group according to pulmonary infection whether occurring after the chemotherapy.The clinical data,including the age,gender,history of diabetes mellitus,history of hypertension,coronary atherosclerotic heart disease(CAHD),chronic obstructive pulmonary disease(COPD),smoking history,operation duration,preoperative lung function,intraoperative blood loss volume and pathological stage,were observed and compared between the two groups of patients.RESULTS Of the 79 esophageal cancer patients who receive the postoperative chemotherapy,27 had pulmonary infection,with the incidence rate 31.18%.The number of the patients with the more than 60 years of age,history of diabetes mellitus,complication of COPD,smoking history and operation duration mreo than 4 hours was significantly larger in the infection group than in the non-infection group(P<0.05).Multivariate logistic regression analysis indicated that the more than 60 years of age,history of diabetes mellitus,complication of COPD,smoking history and operation duration more than 4 hours were the independent risk factors for the pulmonary infection in the esophageal cancer patients undergoing postoperative chemotherapy(P<0.05).Totally 36 strains of pathogens were isolated from the 27 patients with pulmonary infection,among which gram-negative bacteria were dominant.CONCLUSIONThe advanced age,diabetes mellitus,COPD,smoking history and long operation duration are the independent risk factors for the pulmonary infection in the esophageal cancer patients undergoing postoperative chemotherapy.The gram-negative bacteria are dominant among the pathogens causing the pulmonary infection.
OBJECTIVE To explore the risk factors for the pulmonary infection in the radical esophagectomy patients undergoing postoperative chemotherapy and analyze the distribution of pathogens.METHODS From Jan 2015 to Jan 2017,a total of 79 patients with esophageal cancer who received the chemotherapy after the radical esophagectomy were enrolled in the study and divided into the infection group and the non-infection group according to pulmonary infection whether occurring after the chemotherapy.The clinical data,including the age,gender,history of diabetes mellitus,history of hypertension,coronary atherosclerotic heart disease(CAHD),chronic obstructive pulmonary disease(COPD),smoking history,operation duration,preoperative lung function,intraoperative blood loss volume and pathological stage,were observed and compared between the two groups of patients.RESULTS Of the 79 esophageal cancer patients who receive the postoperative chemotherapy,27 had pulmonary infection,with the incidence rate 31.18%.The number of the patients with the more than 60 years of age,history of diabetes mellitus,complication of COPD,smoking history and operation duration mreo than 4 hours was significantly larger in the infection group than in the non-infection group(P<0.05).Multivariate logistic regression analysis indicated that the more than 60 years of age,history of diabetes mellitus,complication of COPD,smoking history and operation duration more than 4 hours were the independent risk factors for the pulmonary infection in the esophageal cancer patients undergoing postoperative chemotherapy(P<0.05).Totally 36 strains of pathogens were isolated from the 27 patients with pulmonary infection,among which gram-negative bacteria were dominant.CONCLUSIONThe advanced age,diabetes mellitus,COPD,smoking history and long operation duration are the independent risk factors for the pulmonary infection in the esophageal cancer patients undergoing postoperative chemotherapy.The gram-negative bacteria are dominant among the pathogens causing the pulmonary infection.
引文
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[6]张克,路遥,李德冰,等.食管癌术后患者肺部感染病原菌分布及对肺功能的影响[J].中华医院感染学杂志,2018,28(1):73-76.
[7]王文生,吴燕芹,刘尚洁,等.食管癌患者术后肺部感染的病原菌耐药性监测[J].中华医院感染学杂志,2014,24(5):1115-1117.
[8]李凡,李标,王琼育,等.食管癌患者行胸腔镜切除术后对肺部感染和炎症细胞因子的影响[J].中华医院感染学杂志,2017,27(17):3944-3947.
[9] Lertbutsayanukul C,Tharavej C,Klaikeaw N,et al.High dose radiation with chemotherapy followed by salvage esophagectomy among patients with locally advanced esophageal squamous cell carcinoma[J].Thorac Cancer,2017,8(3):219-228.
[10] Kudo T,Hamamoto Y,Kato K,et al.Nivolumab treatment for oesophageal squamous-cell carcinoma:an open-label,multicentre,phase 2trial[J].Lancet Oncol,2017,18(5):631-639.
[11]赵松,张岩,李向楠,等.老年食管癌患者术后肺部感染的临床分析[J].中国老年学杂志,2014,34(7):1809-1810.
[12] Martinez-Amador N,Martinez-Rodriguez I,Quirce R,et al.Candida esophagitis incidentally detected by 18F-FDG PET/CT in metastatic lung adenocarcinoma[J].Indian J Nucl Med,2017,32(1):71-72.
[2]蒋倩,蒋刚,马雪,等.食管癌患者围手术期抗菌药物选用与术后肺部感染的相关性研究[J].中华医院感染学杂志,2015,25(11):2459-2460,2464.
[3]徐锦红,李敏,魏琳,等.食管癌术后早期肠内营养预防肺部感染的临床观察[J].中华医院感染学杂志,2013,23(16):3917-3921.
[4]吴剑卿,王云.老年肺部感染的诊断和治疗进展[J].实用老年医学,2014,28(9):711-714.
[5]刘华之,侯良,周瑞芬,等.老年食管癌患者术后并发肺部感染的危险因素和菌群分布及药物敏感性[J].中国老年学杂志,2018,38(12):2865-2867.
[6]张克,路遥,李德冰,等.食管癌术后患者肺部感染病原菌分布及对肺功能的影响[J].中华医院感染学杂志,2018,28(1):73-76.
[7]王文生,吴燕芹,刘尚洁,等.食管癌患者术后肺部感染的病原菌耐药性监测[J].中华医院感染学杂志,2014,24(5):1115-1117.
[8]李凡,李标,王琼育,等.食管癌患者行胸腔镜切除术后对肺部感染和炎症细胞因子的影响[J].中华医院感染学杂志,2017,27(17):3944-3947.
[9] Lertbutsayanukul C,Tharavej C,Klaikeaw N,et al.High dose radiation with chemotherapy followed by salvage esophagectomy among patients with locally advanced esophageal squamous cell carcinoma[J].Thorac Cancer,2017,8(3):219-228.
[10] Kudo T,Hamamoto Y,Kato K,et al.Nivolumab treatment for oesophageal squamous-cell carcinoma:an open-label,multicentre,phase 2trial[J].Lancet Oncol,2017,18(5):631-639.
[11]赵松,张岩,李向楠,等.老年食管癌患者术后肺部感染的临床分析[J].中国老年学杂志,2014,34(7):1809-1810.
[12] Martinez-Amador N,Martinez-Rodriguez I,Quirce R,et al.Candida esophagitis incidentally detected by 18F-FDG PET/CT in metastatic lung adenocarcinoma[J].Indian J Nucl Med,2017,32(1):71-72.