食管癌根治术后肺部感染病原学特点及影响因素Logistic回归分析
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摘要
目的探究食管癌根治术患者术后肺部感染的相关影响因素及导致其感染的病原菌分布特点。方法选择因食管癌行根治术治疗的患者237例,采集患者呼吸道分泌物,对肺部感染患者的病原菌及耐药性进行分析。详细记录患者年龄、性别、体重指数等相关既往病史,记录术前血红蛋白、血浆白蛋白、手术时间及住院时间等相关指标,分别给予单因素和多因素分析。结果共有49例发生感染,感染率为20.68%。感染患者以革兰阴性菌为主,占56.52%,其次为革兰阳性菌,占36.96%;且对目前临床抗菌药物均有一定的耐药性;患者年龄≥60岁、合并有糖尿病、合并有慢性阻塞性肺疾病(COPD)、血浆白蛋白<30g/L及手术时间>4h是导致食管癌根治术患者术后肺部感染的独立影响因素(P<0.05)。结论积极治疗患者糖尿病、COPD等基础疾病、合理饮食,提高自身免疫力、缩短手术时间,根据药敏给予合理的药物治疗,对于降低食管癌根治术患者术后肺部感染的风险有重要意义。
OBJECTIVE To explore the related influencing factors for postoperative pulmonary infection in the patients undergoing esophageal cancer radical surgery and investigate the distribution of pathogens causing the infection.METHODS A total of 237 patients who received esophageal cancer radical surgery were enrolled in the study,the respiratory tract secretions were collected from the patients,the distribution and drug resistance of the pathogens causing the pulmonary infection were observed.The related indexes,including age,gender,body mass index,previous medical history,levels of preoperative hemoglobin and plasma albumin,operation duration and length of hospital stay,were recorded in detail,and the univariate analysis and multivariate analysis were performed.RESULTS Totally 49 patients had infection,with the infection rate 20.68%.Gram-negative bacteria are dominant among the pathogens causing the infection,accounting for 56.52%,followed by gram-positive bacteria(36.96%);the strains were resistant to the clinical antibiotics.The no less than 60 years of age,complication with diabetes mellitus,complication with chronic obstructive pulmonary disease(COPD),plasma albumin less than30 g/L and operation duration more than 4 hours were the independent influencing factors for the postoperative pulmonary infection in the patients undergoing the esophageal cancer radical surgery(P<0.05).CONCLUSIONIt is of great significance to actively treat the underlying diseases such as diabetes mellitus and COPD,arrange reasonable diet,boost the immunity,shorten the operation duration and reasonably use antibiotics based on the result of drug susceptibility testing so as to reduce the risk of postoperative pulmonary infection in the patients undergoing esophageal cancer radical surgery.
OBJECTIVE To explore the related influencing factors for postoperative pulmonary infection in the patients undergoing esophageal cancer radical surgery and investigate the distribution of pathogens causing the infection.METHODS A total of 237 patients who received esophageal cancer radical surgery were enrolled in the study,the respiratory tract secretions were collected from the patients,the distribution and drug resistance of the pathogens causing the pulmonary infection were observed.The related indexes,including age,gender,body mass index,previous medical history,levels of preoperative hemoglobin and plasma albumin,operation duration and length of hospital stay,were recorded in detail,and the univariate analysis and multivariate analysis were performed.RESULTS Totally 49 patients had infection,with the infection rate 20.68%.Gram-negative bacteria are dominant among the pathogens causing the infection,accounting for 56.52%,followed by gram-positive bacteria(36.96%);the strains were resistant to the clinical antibiotics.The no less than 60 years of age,complication with diabetes mellitus,complication with chronic obstructive pulmonary disease(COPD),plasma albumin less than30 g/L and operation duration more than 4 hours were the independent influencing factors for the postoperative pulmonary infection in the patients undergoing the esophageal cancer radical surgery(P<0.05).CONCLUSIONIt is of great significance to actively treat the underlying diseases such as diabetes mellitus and COPD,arrange reasonable diet,boost the immunity,shorten the operation duration and reasonably use antibiotics based on the result of drug susceptibility testing so as to reduce the risk of postoperative pulmonary infection in the patients undergoing esophageal cancer radical surgery.
引文
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[10]邱龙,赵松,朱登彦,等.食管癌术后吻合口瘘感染患者病原菌分布及其耐药性[J].中国感染控制杂志,2017,16(9):833-836.
[11]Horakova M,Lubuska L,Kolar M,et al.Individualized prophylaxis in patients with esophageal replacement because of cancer[J].Surg Infect(Larchmt),2015,16(5):513-517.
[12]Moghtadaei M,Hashemi Golpayegani MR,Almasganj F,et al.Predicting the risk of squamous dysplasia and esophageal squamous cell carcinoma using minimum classification error method[J].Comput Biol Med,2014,45:51-57.
[2]沙纪名,石开虎,吴君旭,等.全腔镜下食管癌根治术中留置胸腔闭式引流管联合纵隔引流管效果观察[J].山东医药,2015,55(39):56-58.
[3]文玉琴,何丽,李丽霞,等.胸腹腔镜联合食管癌根治术患者感染预防与控制研究[J].中华医院感染学杂志,2016,26(1):98-99.
[4]许启霞,詹庆元.中华医学会呼吸病学分会第一届呼吸危重症论坛会议纪要[J].中华结核和呼吸杂志,2015,38(9):714-715.
[5]张雅薇,王辉.2016年CLSIM100S(第26版)主要更新内容解读[J].中华检验医学杂志,2016,39(3):165-169.
[6]许根友.学习《全国临床检验操作规程》(第3版)第一篇对检验工作的实际意义[J].临床血液学杂志(输血与检验版),2010,23(6):759-760.
[7]徐燕明,陈泽湘.食管癌根治术后发生胸腔感染的危险因素分析及护理干预[J].实用临床医药杂志,2015,19(16):60-63.
[8]王希文,任开明,刘海君,等.364例食管癌根治术后并发症的影响因素分析[J].临床外科杂志,2017,25(2):135-138.
[9]许治国.食管癌患者根治术后预防性放疗对患者预后的影响[J].转化医学电子杂志,2016,3(3):19-21.
[10]邱龙,赵松,朱登彦,等.食管癌术后吻合口瘘感染患者病原菌分布及其耐药性[J].中国感染控制杂志,2017,16(9):833-836.
[11]Horakova M,Lubuska L,Kolar M,et al.Individualized prophylaxis in patients with esophageal replacement because of cancer[J].Surg Infect(Larchmt),2015,16(5):513-517.
[12]Moghtadaei M,Hashemi Golpayegani MR,Almasganj F,et al.Predicting the risk of squamous dysplasia and esophageal squamous cell carcinoma using minimum classification error method[J].Comput Biol Med,2014,45:51-57.