肺功能指标对食管癌患者术后肺部感染的预测价值
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摘要
目的探讨相关肺功能指标对食管癌患者术后肺部感染的预测价值。方法回顾性分析2014年8月-2017年12月在医院进行手术治疗的231例食管癌患者的临床资料,按照患者术后是否发生肺部感染分为两组,单因素与多因素分析的方法筛选患者发生肺部感染的独立影响因素,探讨多种肺功能指标对食管癌患者术后肺部感染的预测价值。结果 231例患者食管癌手术治疗后,共有34例患者在手术后发生了肺部感染,肺部感染率为14.72%,年龄偏大,吸烟,一秒用力呼气容积较低,最大通气量较低,呼气流量峰值较低,一氧化碳弥散量较低,手术时间较长,呼吸机使用时间较长,抗菌药物使用时间较长,为食管癌手术患者发生肺部感染的独立影响因素(P<0.05),呼气流量峰值诊断患者发生肺部感染的ROC曲线下面积最高为0.957。结论多种肺功能指标均可以预测食管癌患者手术后是否发生肺部感染,其中呼吸流量峰值是一个较为新颖的预测指标,在各类肺功能指标的比较中,其诊断价值较高,可以推测该指标对食管癌患者手术后是否发生肺部感染拥有一定的预测意义,但是尚需要大样本量的研究结果进行数据支持。
OBJECTIVE To explore the value of related lung function indexes in prediction of postoperative pulmonary infection in patients with esophageal cancer.METHODS The clinical data of 231 esophageal cancer patients who received surgical procedures in the hospital from Aug 2014 to Dec 2017 were retrospectively analyzed,the enrolled patients were divided into two groups according to the status of postoperative pulmonary infection,univariate analysis and multivariate analysis were performed to screen out the independent influencing factors for the pulmonary infection,and the value of the multiple lung function indexes in prediction of the postoperative pulmonary infection was explored.RESULTS Of the 231 esophageal cancer patients who received the surgical procedures,34 had postoperative pulmonary infection,with the infection rate 14.72%.The independent influencing factors for the pulmonary infection in the esophageal cancer patients included old age,smoking,low forced expiratory volume in one second,low maximum minute ventilation,low peak expiratory flow,low carbon monoxide diffusion,long operation duration,long time use of ventilator and long time of use of antibiotics(P<0.05),the highest area under ROC curve of the peak of expiratory flow was 0.957 in diagnosis of pulmonary infection.CONCLUSION Multiple lung function indexes can be used for prediction of the postoperative pulmonary infection in the patients with esophageal cancer.As a novel prediction index,the peak of expiratory flow has high diagnostic value and certain significance in prediction of the postoperative pulmonary infection in the patients with esophageal cancer,however,large sample size of research results are needed for data support.
OBJECTIVE To explore the value of related lung function indexes in prediction of postoperative pulmonary infection in patients with esophageal cancer.METHODS The clinical data of 231 esophageal cancer patients who received surgical procedures in the hospital from Aug 2014 to Dec 2017 were retrospectively analyzed,the enrolled patients were divided into two groups according to the status of postoperative pulmonary infection,univariate analysis and multivariate analysis were performed to screen out the independent influencing factors for the pulmonary infection,and the value of the multiple lung function indexes in prediction of the postoperative pulmonary infection was explored.RESULTS Of the 231 esophageal cancer patients who received the surgical procedures,34 had postoperative pulmonary infection,with the infection rate 14.72%.The independent influencing factors for the pulmonary infection in the esophageal cancer patients included old age,smoking,low forced expiratory volume in one second,low maximum minute ventilation,low peak expiratory flow,low carbon monoxide diffusion,long operation duration,long time use of ventilator and long time of use of antibiotics(P<0.05),the highest area under ROC curve of the peak of expiratory flow was 0.957 in diagnosis of pulmonary infection.CONCLUSION Multiple lung function indexes can be used for prediction of the postoperative pulmonary infection in the patients with esophageal cancer.As a novel prediction index,the peak of expiratory flow has high diagnostic value and certain significance in prediction of the postoperative pulmonary infection in the patients with esophageal cancer,however,large sample size of research results are needed for data support.
引文
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[19]Ma G,Zhang X,Ma Q,et al.A novel multivariate scoring system for determining the prognosis of lymph node-negative esophageal squamous cell carcinoma following surgicat therapy:an observational study[J].Eur J Surg Oncol,2015,41(4):541-547.
[20]Markar S,Gronnier C,Duhamel A,et al.Pattern of postoperative mortality after esophageal cancer resection according to center volume:results from a large European multicenter study[J].Ann Surg Oncol,2015,22(8):2615-2623.
[21]Yoshida R,Morita M,Shoji F,et al.Clinical significance of SIP1and E-cadherin in patients with esophageal squamous cell carcinoma[J].Ann Surg Oncol,2015,22(8):2608-2614.
[22]Kageyama S,Ikeda H,Miyahara Y,et al.Adoptive transfer of MAGE-A4T-cell receptor gene-transduced lymphocytes in patients with recurrent esophageal cancer[J].Clin Cancer Res,2015,21(10):2268-2277.
[23]中华医学会呼吸病学分会肺功能专业组.肺功能检查指南-呼气峰值流量及其变异率检查[J].中华结核和呼吸杂志,2017,40(6):426-430.
[24]蒋虹,李隽,童皖宁,等.肺功能指数对肺癌胸腔镜术后患者肺部感染的影响[J].中国临床医生杂志,2018,46(5):576-578.
[25]Allen S,Yeung P,Janczewski M,et al.Predicting inadequate spirometry technique and the use of FEVl/FEV3as an alternative to FEVI/FVC for patients with mild cognitive impairment[J].Clin Respir J,2008,2(4):208-213.
[2]Bakhos CT,Fabian T,Oyasiji TO,et al.Impact of the surgical technique on pulmonary morbidity after esophagectomy[J].Ann Thorac Surg,2012,93(1):221-227.
[3]谭何易,唐胜军,罗永强,等.食管癌患者术后肺部感染的病原菌分布及其药物敏感性[J].中华实验和临床感染病杂志(电子版),2017,11(1):56-59.
[4]Chiam K,Wang T,Watson DI,et al.Circulating serum exosomal miRNAs as potential biomarkers for esophageal adenocarcinoma[J].J Gastrointest Surg,2015,19(7):1208-1215.
[5]Ide S,Toiyama YJ,Shimura T,et al.Angiopoietin-like protein 2acts as a novel biomarker for diagnosis and prognosis in patients with esophageal cancer[J].Ann Surg Oncol,2015,22(8):2585-2592.
[6]Low DE,Alderson D,Cecconello I,et al.International consensus on standardization of data collection for complications associated with esophagectomy:esophageetomy complications consensus group(EC-CG)[J].Ann Surg,2015,262(2):286-294.
[7]鞠继银.食管癌术后肺部感染因素分析及强化护理[J].实用临床医药杂志,2018,22(6):60-63.
[8]赵良辉,徐中菊.食管癌放疗患者院内感染调查及相关预防措施研究[J].中国医学前沿杂志(电子版),2018,10(4):45-49.
[9]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.
[10]董伟,魏然,吴志南,等.呼气流量峰值与食管癌患者术后肺部感染的相关性及预测价值分析[J].中华胸心血管外科杂志,2017,33(9):557-560.
[11]Wu HL,Xiao WZ,Xu XJ,et al.Relationship of tidal volume to peak flow,breath rate,I:E and plateau time:mock study[J].Am J Med Sci,2015,349(4):312-315.
[12]许彬东,黄国忠,陈豪,等.术前肠内营养对食管癌围手术期营养状态、免疫功能与应激反应的影响[J].肠外与肠内营养,2018,25(4):204-208.
[13]中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.
[14]American Thoracic Society,Infectious Diseases Society of A-merica.Guidelines for the management of adults with hospital-acquired,vent-ilator-associated,and heahhcare-associated pneumonia[J].Am J Respir Crit Care Med,2005,171(4):388-416.
[15]丁晓权,毕鑑红,马志刚,等.食管癌组织中ERCC1和GSTP1表达量与铂类化疗药物敏感性及凋亡、增殖基因表达量的相关性[J].海南医学院学报,2017,23(6):809-812.
[16]Kubo N,Ohira M,Yamashita Y,et al.The impact of combined thoracoscopic and laparoscopic surgery on pulmonary complications after radical esophageetomy in patients with resectable esophageal cancer[J].Anticancer Res,2014,34(5):2399-2404.
[17]Sunpaweravong S,Ruangsin S,Laohawiriyakamol S,et al.Prediction of major postoperative complications and survival for locally advanced esophageal carcinoma patients[J].Asian J Surg,2012,35(3):104-109.
[18]Ferguson MK,Celauro AD,Prachand V.Prediction of major pulmonary complications after esophageetomy[J].Ann Thorac Surg,2011,91(5):1494-1501.
[19]Ma G,Zhang X,Ma Q,et al.A novel multivariate scoring system for determining the prognosis of lymph node-negative esophageal squamous cell carcinoma following surgicat therapy:an observational study[J].Eur J Surg Oncol,2015,41(4):541-547.
[20]Markar S,Gronnier C,Duhamel A,et al.Pattern of postoperative mortality after esophageal cancer resection according to center volume:results from a large European multicenter study[J].Ann Surg Oncol,2015,22(8):2615-2623.
[21]Yoshida R,Morita M,Shoji F,et al.Clinical significance of SIP1and E-cadherin in patients with esophageal squamous cell carcinoma[J].Ann Surg Oncol,2015,22(8):2608-2614.
[22]Kageyama S,Ikeda H,Miyahara Y,et al.Adoptive transfer of MAGE-A4T-cell receptor gene-transduced lymphocytes in patients with recurrent esophageal cancer[J].Clin Cancer Res,2015,21(10):2268-2277.
[23]中华医学会呼吸病学分会肺功能专业组.肺功能检查指南-呼气峰值流量及其变异率检查[J].中华结核和呼吸杂志,2017,40(6):426-430.
[24]蒋虹,李隽,童皖宁,等.肺功能指数对肺癌胸腔镜术后患者肺部感染的影响[J].中国临床医生杂志,2018,46(5):576-578.
[25]Allen S,Yeung P,Janczewski M,et al.Predicting inadequate spirometry technique and the use of FEVl/FEV3as an alternative to FEVI/FVC for patients with mild cognitive impairment[J].Clin Respir J,2008,2(4):208-213.