气道定植菌对肺癌患者术后肺部感染的影响因素分析
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摘要
目的探讨气道定植菌对肺癌患者术后肺部感染的影响因素。方法选取2014年2月-2016年10月于医院接受治疗的102例非小细胞肺癌患者为研究对象,手术前经纤维支气管镜及气管内液进行细菌取样,按照样本中是否有气道定植菌将患者分为试验组54例和对照组48例,其中试验组术前患有气道定植菌,对照组术前检测结果为无气道定植菌。术后对其进行血清肺表面活性蛋白D含量(surfactant protein,SP-D)检测,分析肺癌患者术后并发症情况;采集患者术后咳痰行病原菌分析,并归纳肺癌患者术后肺部感染的影响因素。结果试验组肺部感染率为25.93%(14/54)高于对照组6.25%(3/48)(P=0.024)。试验组中出现乳糜胸1例,皮下气肿2例,肺栓塞1例,声音嘶哑1例,试验组并发症患者共19例;对照组中出现乳糜胸1例,声音嘶哑1例,对照组并发症患者共5例低于试验组(P=0.032);试验组患者术前血清SP-D水平(32.01±5.98)ng/ml高于对照组(P=0.042)。感染患者共培养分离病原菌28株,其中革兰阳性菌15株,革兰阴性菌12株,真菌1株;共检出8株定植菌,其中肺炎克雷伯菌2株,铜绿假单胞菌2株,大肠埃希菌1株;金黄色葡萄球菌1株,肺炎链球菌1株;白假丝酵母1株;高龄、术前有气道定植菌是肺癌患者术后肺部感染的影响因素(P<0.05)。结论气道定植菌会增加肺癌患者术后肺部感染概率,而高龄是导致术后肺部感染的关键因素,临床应重点关注此类患者并采取相应的预防措施。
OBJECTIVE To explore the effect of airway colonization bacteria on postoperative pulmonary infection in patients with lung cancer.METHODS 102 patients with non-small cell lung cancer received treatment in our hospital from Feb.2014 to Oct.2016 were selected as the research objects.Preoperative fiberoptic bronchoscopy and endotracheal fluid bacterial sampling was conducted,and the patients were divided into two groups according to presence of airway colonization bacteria,including 54 cases of patients with preoperative detection of airway colonization bacteria as observation group,and 48 cases of patients without airway colonization bacteria as the control group.Postoperative serum lung surfactant protein D content(surfactant protein,SP-D)was detected,and postoperative complications in lung cancer patients were analyzed.Respiratory tract secretions of patients were collected for pathogens analysis,and the influencing factors of postoperative pulmonary infection in patients with lung cancer were summarized.RESULTS The pulmonary infection rate in the observation group was 25.93%(14/54),significantly higher than that in the control group which was 6.25%(3/48)(P=0.024).There were 1 case of chylothorax,2 cases of subcutaneous emphysema,1 case of pulmonary embolism,1 case of hoarseness and 19 cases of complications in the observation group.1 case of chylothorax,1 case of hoarseness and 5 cases of complications occurred in the control group,with significantly lower incidences than those in the observation group(P=0.032).The preoperative serum SP-D level in the observation group was(32.01±5.98)ng/ml,significantly higher than that of the control group(P=0.042).17 strains of pathogens were co-cultured and isolated from the infected patients,including 15 strains of gram-positive bacteria,12 strains of gram-negative bacteria and 1 strain of fungus.A total of 8 straisn of colonization bacteria were detected,including 2 strains of Klebsiella pneumoniae,2 strains of Pseudomonas aeruginosa,1 strain of Escherichia coli,1 strain of Staphylococcus aureus,1 strain of Streptococcus pneumoniae,and 1 strain of Candida albicans.Advanced age and preoperative airway colonization bacteria were the influencing factors of postoperative pulmonary infection in patients with lung cancer(P<0.05).CONCLUSION Airway colonization bacteria can significantly increase the possibility of pulmonary infection in patients with lung cancer,and age is the key factor leading to high incidence of postoperative pulmonary infection.The clinicians should pay special attention to these patients and take corresponding preventive measures.
OBJECTIVE To explore the effect of airway colonization bacteria on postoperative pulmonary infection in patients with lung cancer.METHODS 102 patients with non-small cell lung cancer received treatment in our hospital from Feb.2014 to Oct.2016 were selected as the research objects.Preoperative fiberoptic bronchoscopy and endotracheal fluid bacterial sampling was conducted,and the patients were divided into two groups according to presence of airway colonization bacteria,including 54 cases of patients with preoperative detection of airway colonization bacteria as observation group,and 48 cases of patients without airway colonization bacteria as the control group.Postoperative serum lung surfactant protein D content(surfactant protein,SP-D)was detected,and postoperative complications in lung cancer patients were analyzed.Respiratory tract secretions of patients were collected for pathogens analysis,and the influencing factors of postoperative pulmonary infection in patients with lung cancer were summarized.RESULTS The pulmonary infection rate in the observation group was 25.93%(14/54),significantly higher than that in the control group which was 6.25%(3/48)(P=0.024).There were 1 case of chylothorax,2 cases of subcutaneous emphysema,1 case of pulmonary embolism,1 case of hoarseness and 19 cases of complications in the observation group.1 case of chylothorax,1 case of hoarseness and 5 cases of complications occurred in the control group,with significantly lower incidences than those in the observation group(P=0.032).The preoperative serum SP-D level in the observation group was(32.01±5.98)ng/ml,significantly higher than that of the control group(P=0.042).17 strains of pathogens were co-cultured and isolated from the infected patients,including 15 strains of gram-positive bacteria,12 strains of gram-negative bacteria and 1 strain of fungus.A total of 8 straisn of colonization bacteria were detected,including 2 strains of Klebsiella pneumoniae,2 strains of Pseudomonas aeruginosa,1 strain of Escherichia coli,1 strain of Staphylococcus aureus,1 strain of Streptococcus pneumoniae,and 1 strain of Candida albicans.Advanced age and preoperative airway colonization bacteria were the influencing factors of postoperative pulmonary infection in patients with lung cancer(P<0.05).CONCLUSION Airway colonization bacteria can significantly increase the possibility of pulmonary infection in patients with lung cancer,and age is the key factor leading to high incidence of postoperative pulmonary infection.The clinicians should pay special attention to these patients and take corresponding preventive measures.
引文
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[16] Kawabata T,Higashimoto I,Takashima H,et al.Human T-lymphotropic virus type I(HTLV-I)-specific CD8+cells accumulate in the lungs of patients infected with HTLV-I with pulmonary involvement[J].J Med Virol,2012,84(7):1120-1127.
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[18] Ivan FX,Rajapakse JC,Welsch RE,et al.Differential pulmonary transcriptomic profiles in murine lungs infected with low and highly virulent influenza H3N2viruses reveal dysregulation of TREM1signaling,cytokines,and chemokines[J].Funct Integr Genomics,2012,12(1):105-117.
[2]丁巧玲,吴丽仙,吴菊莲,等.人工气道患者痰菌谱分析及护理对策[J].中华医院感染学杂志,2011,21(7):1325-1326.
[3]骆雪萍,施善阳,王玉春,等.重症监护病房呼吸机相关真菌肺炎临床特点及危险因素的前瞻性研究[J].现代预防医学,2014,41(18):3412-3414,3429.
[4]牛凯丽.不同护理干预模式对机械通气患者肺部感染的影响[J].西南国防医药,2014,24(10):1135-1136.
[5]高珂,赖玉田,黄健,等.肺癌肺叶切除患者术前存在气道定植菌与术后肺炎的发生有相关性吗[J].中国肺癌杂志,2017,20(4):239-247.
[6] Ciofu O,Johansen HK,Aanaes K,et al.P.aeruginosain the paranasal sinuses and transplanted lungs have similar adaptive mutations as isolates from chronically infected CF lungs[J].J Cyst Fibros,2013,12(6):729-736.
[7]刘琳,张湘燕,高占成等.气道分泌物病原菌培养在呼吸系统感染诊断中的应用价值[J].山东医药,2016,56(31):103-105.
[8]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.
[9] Joag V,Obila O,Gajer P,et al.Impact of standard bacterial vaginosis treatment on the genital microbiota,immune milieu,and ex vivo human immunodeficiency virus susceptibility[J].Clin Infect Dis,2018.
[10]张艳红.老年肺癌患者术后并发肺部感染的相关因素及干预措施[J].中华医院感染学杂志,2013,23(11):2554-2556.
[11] Zhao FR,Su S,Zhou DH,et al.Comparative analysis of microRNAs from the lungs and trachea of dogs(Canis familiaris)infected with canine influenza virus[J].Infect Genet Evol,2014,21:367-374.
[12]陈谨,何耀红,呼玮,等.老年慢性阻塞性肺疾病稳定期患者下呼吸道细菌定植与细胞免疫功能缺陷的关系研究[J].中国全科医学,2014,18(10):1124-1128.
[13] Kovner AV,Anikina AG,Potapova OV,et al.Structural and functional changes in pulmonary macrophages and lungs of mice infected with infl uenza virus A/H5N1 A/goose/Krasnoozerskoye/627/05[J].Bull Exp Biol Med,2012,153(2):229-232.
[14]Unno A,Kachi S,Batanova TA,et al.Toxoplasma gondii tachyzoite-infected peripheral blood mononuclear cells are enriched in mouse lungs and liver.[J].Exp Parasitol,2013,134(2):160-164.
[15] Kim CH,Oh Y,Han K,et al.Expression of secreted mucins(MUC2,MUC5AC,MUC5B,and MUC6)and membranebound mucin(MUC4)in the lungs of pigs experimentally infected with Actinobacillus pleuropneumoniae[J].Res Vet Sci,2012,92(3):486-491.
[16] Kawabata T,Higashimoto I,Takashima H,et al.Human T-lymphotropic virus type I(HTLV-I)-specific CD8+cells accumulate in the lungs of patients infected with HTLV-I with pulmonary involvement[J].J Med Virol,2012,84(7):1120-1127.
[17] Anikina AG,Potapova OV,Shkurupii VA,et al.Role of matrix metalloproteinases and their inhibitor in the development of early pulmonary fibrosis in mice infected with influenza A/H5N1 A/GOOSE/Krasnoozerskoye/627/05 virus[J].Bull Exp Biol Med,2013,156(1):11-14.
[18] Ivan FX,Rajapakse JC,Welsch RE,et al.Differential pulmonary transcriptomic profiles in murine lungs infected with low and highly virulent influenza H3N2viruses reveal dysregulation of TREM1signaling,cytokines,and chemokines[J].Funct Integr Genomics,2012,12(1):105-117.