腹腔镜胃癌根治术患者术后肺部感染与影响因素分析
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摘要
目的研究腹腔镜胃癌根治术患者术后肺部感染与影响因素,探究相应的防治对策。方法回顾性分析2014年3月-2017年3月于医院行腹腔镜胃癌根治术的患者340例的临床资料,分析病原菌情况,比较患者感染前后血清白细胞(WBC)、中性粒细胞比例(NEUT%)、C-反应蛋白(CRP)等指标;收集患者性别、既往史、住院情况等临床资料,归纳腹腔镜胃癌根治术患者术后肺部感染的影响因素。结果行腹腔镜胃癌根治术患者术后肺部感染率为9.41%(32/340);共培养分离病原菌36株,其中革兰阴性菌20株占55.56%,以肺炎克雷伯菌为主;革兰阳性菌13株占36.11%,真菌3株占8.33%。合并糖尿病、低蛋白血症、围手术期输血是腹腔镜胃癌根治术患者术后肺部感染的影响因素(P<0.05)。感染后患者的WBC、NEUT%、CRP分别为(11.04±2.83)×109/L、(79.02±9.37)%、(50.01±54.28)mg/L高于感染前(P<0.05)。结论腹腔镜老年胃癌根治术患者发生医院感染的主要病原菌是肺炎克雷伯菌,低蛋白血症、合并糖尿病、围手术期输血与患者术后发生肺部感染密切相关。临床应针对高危因素采取有效预防措施,降低肺部感染率。
OBJECTIVE To study the indicators and risk factors of postoperative pulmonary infection in patients after laparoscopic radical resection of gastric cancer,and to explore the corresponding prevention and control countermeasures.METHODSThe clinical data of 340 patients who underwent laparoscopic radical gastrectomy in the hospital from Mar.2014 to Mar.2017 were retrospectively analyzed.The pathogens were analyzed and the serum leukocyte(WBC),neutrophil ratios(NEUT%)and C-reactive protein(CRP)were compared before and after infection.The clinical data of the patients such as gender,past history and hospitalization were collected,and the influencing factors of pulmonary infection after laparoscopic radical gastrectomy were summarized.RESULTS The incidence of postoperative pulmonary infection in patients undergoing laparoscopic radical gastrectomy was 9.41%(32/340).36 strains of pathogens were isolated and co-cultured,of which 20 strains of gram-negative bacteria accounted for 55.56%,mainly Klebsiella pneumoniae,13 strains of gram-positive bacteria accounted for36.11%,and 3 strains of fungi accounted for 8.33%.Diabetes mellitus,hypoproteinemia and perioperative blood transfusion were the influencing factors of pulmonary infection after laparoscopic radical gastrectomy(P<0.05).The WBC,NEUT%,and CRP of the patients after infection were(11.04±2.83)×109/L,(79.02±9.37)%,and(50.01±54.28)mg/L,respectively,higher than those before infection(P <0.05).CONCLUSION The main pathogen causing nosocomial infection in elderly patients undergoing laparoscopic radical gastrectomy is K pneumoniae.Hypoalbuminemia,diabetes mellitus,and perioperative blood transfusion are closely related with postoperative pulmonary infection in the patients.The clinicians should take effective preventive measures based on the risk factors,so as to reduce the incidence of pulmonary infection.
OBJECTIVE To study the indicators and risk factors of postoperative pulmonary infection in patients after laparoscopic radical resection of gastric cancer,and to explore the corresponding prevention and control countermeasures.METHODSThe clinical data of 340 patients who underwent laparoscopic radical gastrectomy in the hospital from Mar.2014 to Mar.2017 were retrospectively analyzed.The pathogens were analyzed and the serum leukocyte(WBC),neutrophil ratios(NEUT%)and C-reactive protein(CRP)were compared before and after infection.The clinical data of the patients such as gender,past history and hospitalization were collected,and the influencing factors of pulmonary infection after laparoscopic radical gastrectomy were summarized.RESULTS The incidence of postoperative pulmonary infection in patients undergoing laparoscopic radical gastrectomy was 9.41%(32/340).36 strains of pathogens were isolated and co-cultured,of which 20 strains of gram-negative bacteria accounted for 55.56%,mainly Klebsiella pneumoniae,13 strains of gram-positive bacteria accounted for36.11%,and 3 strains of fungi accounted for 8.33%.Diabetes mellitus,hypoproteinemia and perioperative blood transfusion were the influencing factors of pulmonary infection after laparoscopic radical gastrectomy(P<0.05).The WBC,NEUT%,and CRP of the patients after infection were(11.04±2.83)×109/L,(79.02±9.37)%,and(50.01±54.28)mg/L,respectively,higher than those before infection(P <0.05).CONCLUSION The main pathogen causing nosocomial infection in elderly patients undergoing laparoscopic radical gastrectomy is K pneumoniae.Hypoalbuminemia,diabetes mellitus,and perioperative blood transfusion are closely related with postoperative pulmonary infection in the patients.The clinicians should take effective preventive measures based on the risk factors,so as to reduce the incidence of pulmonary infection.
引文
[1]肖华,左朝晖,欧阳永忠,等.胃癌根治术后肺部感染的危险因素分析[J].中华医学杂志,2014,94(42):3310-3313.
[2]刘大勇,张剑,陈坤,等.胃癌患者胃切除术后肺部感染的影响因素回顾性调查分析[J].中华医院感染学杂志,2017,27(7):1576-1579.
[3] Hayashi T,Yoshikawa T,Aoyama T,et al.Impact of infectious complications on gastric cancer recurrence[J].Gastric Cancer,2015,18(2):368-374.
[4] Kubota T,Hiki N,Sano T,et al.Prognostic significance of complications after curative surgery for gastric cancer.[J].Ann Surg Oncol,2014,21(3):891-898.
[5]许文婷,谢佳明,程孝惠,等.胃癌患者术后肺部感染病原菌分布及围手术期干预措施研究[J].中华医院感染学杂志,2018,28(13):1987-1989.
[6]陈海珠,黄维芬,郭海萍,等.改良式体位引流在消化外科肺部感染患者中的应用研究[J].中华医院感染学杂志,2016,26(4):857-858.
[7] Takeuchi D,Koide N,Suzuki A,et al.Postoperative complications in elderly patients with gastric cancer[J].J Surg Res,2015,198(2):317-326.
[8] Saito T,Kurokawa Y,Miyazaki Y,et al.Which is a more reliable indicator of survival after gastric cancer surgery:postoperative complication occurrence or C-reactive protein elevation?[J].J Surg Oncol,2016,112(8):894-899.
[9]张立飞.腹腔镜辅助胃癌根治手术对进展期胃癌的远期疗效分析[J].中国现代普通外科进展,2014,17(8):629-630.
[10] Postlewait LM,Maithel SK.Response:increased complications associated with feeding jejunostomy in gastrectomy for gastric cancer:chicken or the egg[J].J Surg Oncol,2016,113(1):121.
[11]刁亚利,范黄新,施庆彤.全腔镜手术对食管癌术后肺部感染影响的临床分析[J].实用临床医药杂志,2016,20(21):203-204.
[12] Fecso A B,Bhatti J A,Stotland P K,et al.Technical performance as a predictor of complications in laparoscopic gastric cancer surgery:another piece of the puzzle[J].J Am Coll Surg,2017,225(4):S92.
[13]杨晟,翁金森,郑庆丰,等.机械通气联合纤维支气管镜治疗腔镜食管癌根治术后重症肺部感染57例[J].福建医药杂志,2015,37(5):16-19.
[14]韩晓光,步召德,季加孚.胃癌根治术后肺部感染相关危险因素分析[J].中华胃肠外科杂志,2017,20(11):1279-1282.
[15] Madouri F,Barada O,Kervoaze G,et al.Production of interleukin-20cytokines limits bacterial clearance and lung inflammation during infection by Streptococcus pneumoniae[J].EBioMedicine,2018,37:417-427.
[16] Suzuki H,Matsuda Y,Noda M,et al.Management of de novo mycobacterial infection after lung transplantation without rifampicin case series of a single institution[J].Transplant Proc,2018,50(9):2764-2767.
[17] Stojanovic J,Tognetto A,Tiziano DF,et al.MicroRNAs expression profiles as diagnostic biomarkers of gastric cancer:a systematic literature review[J].Biomarkers,2018,2:1-10.
[18]滕莉,付阿丹,张星,等.改良式体位引流治疗老年性胃癌术后肺部感染的效果观察[J].中国实用护理杂志,2015,31(11):806-808.
[19] Seo S,Ryu MH,Park YS,et al.Loss of HER2positivity after anti-HER2chemotherapy in HER2-positive gastric cancer patients:results of the GASTric cancer HER2reassessment study 3(GASTHER3)[J].Gastric Cancer,2018,10:1-9.
[20]李文惠,刘宏斌,韩晓鹏,等.老年病人胃癌术后呼吸道并发症的防治[J].现代肿瘤医学,2007,15(3):387-388.
[2]刘大勇,张剑,陈坤,等.胃癌患者胃切除术后肺部感染的影响因素回顾性调查分析[J].中华医院感染学杂志,2017,27(7):1576-1579.
[3] Hayashi T,Yoshikawa T,Aoyama T,et al.Impact of infectious complications on gastric cancer recurrence[J].Gastric Cancer,2015,18(2):368-374.
[4] Kubota T,Hiki N,Sano T,et al.Prognostic significance of complications after curative surgery for gastric cancer.[J].Ann Surg Oncol,2014,21(3):891-898.
[5]许文婷,谢佳明,程孝惠,等.胃癌患者术后肺部感染病原菌分布及围手术期干预措施研究[J].中华医院感染学杂志,2018,28(13):1987-1989.
[6]陈海珠,黄维芬,郭海萍,等.改良式体位引流在消化外科肺部感染患者中的应用研究[J].中华医院感染学杂志,2016,26(4):857-858.
[7] Takeuchi D,Koide N,Suzuki A,et al.Postoperative complications in elderly patients with gastric cancer[J].J Surg Res,2015,198(2):317-326.
[8] Saito T,Kurokawa Y,Miyazaki Y,et al.Which is a more reliable indicator of survival after gastric cancer surgery:postoperative complication occurrence or C-reactive protein elevation?[J].J Surg Oncol,2016,112(8):894-899.
[9]张立飞.腹腔镜辅助胃癌根治手术对进展期胃癌的远期疗效分析[J].中国现代普通外科进展,2014,17(8):629-630.
[10] Postlewait LM,Maithel SK.Response:increased complications associated with feeding jejunostomy in gastrectomy for gastric cancer:chicken or the egg[J].J Surg Oncol,2016,113(1):121.
[11]刁亚利,范黄新,施庆彤.全腔镜手术对食管癌术后肺部感染影响的临床分析[J].实用临床医药杂志,2016,20(21):203-204.
[12] Fecso A B,Bhatti J A,Stotland P K,et al.Technical performance as a predictor of complications in laparoscopic gastric cancer surgery:another piece of the puzzle[J].J Am Coll Surg,2017,225(4):S92.
[13]杨晟,翁金森,郑庆丰,等.机械通气联合纤维支气管镜治疗腔镜食管癌根治术后重症肺部感染57例[J].福建医药杂志,2015,37(5):16-19.
[14]韩晓光,步召德,季加孚.胃癌根治术后肺部感染相关危险因素分析[J].中华胃肠外科杂志,2017,20(11):1279-1282.
[15] Madouri F,Barada O,Kervoaze G,et al.Production of interleukin-20cytokines limits bacterial clearance and lung inflammation during infection by Streptococcus pneumoniae[J].EBioMedicine,2018,37:417-427.
[16] Suzuki H,Matsuda Y,Noda M,et al.Management of de novo mycobacterial infection after lung transplantation without rifampicin case series of a single institution[J].Transplant Proc,2018,50(9):2764-2767.
[17] Stojanovic J,Tognetto A,Tiziano DF,et al.MicroRNAs expression profiles as diagnostic biomarkers of gastric cancer:a systematic literature review[J].Biomarkers,2018,2:1-10.
[18]滕莉,付阿丹,张星,等.改良式体位引流治疗老年性胃癌术后肺部感染的效果观察[J].中国实用护理杂志,2015,31(11):806-808.
[19] Seo S,Ryu MH,Park YS,et al.Loss of HER2positivity after anti-HER2chemotherapy in HER2-positive gastric cancer patients:results of the GASTric cancer HER2reassessment study 3(GASTHER3)[J].Gastric Cancer,2018,10:1-9.
[20]李文惠,刘宏斌,韩晓鹏,等.老年病人胃癌术后呼吸道并发症的防治[J].现代肿瘤医学,2007,15(3):387-388.