开胸术后肺部感染的高危因素分析

Analysis of high risk factors in post thoracotomy pulmonary infection

目的分析开胸术后肺部感染（ＰＴＰＩ）的高危因素，为制定相应防治措施作参考。方法回顾性分析１２０例ＰＴＰＩ患者的年龄、术前肺功能、手术类型、肺内感染病灶和麻醉插管类型、抗生素预防应用和围手术期护理等多因素与其发病的关系，所得资料进行ｃｈｉｓｑｕａｒｅ检验。结果６０岁以上、肺功能ＭＶＶ＜７０％、ＦＥＶ１％＜６０％患者ＰＴＰＩ发生率明显增高。食管癌根治颈部及弓上吻合ＰＴＰＩ发生率较弓下吻合增高（Ｐ＜００１）。肺癌纵隔淋巴结清扫术后ＰＴＰＩ发生率高于不作清扫术者（Ｐ＜００１）。肺内有感染病灶及采用单腔插管麻醉者ＰＴＰＩ发生率明显增高。结论高龄、肺功能低下、高位食管手术、纵隔淋巴结清扫术、肺内感染病灶及单腔插管麻醉是ＰＴＰＩ发病的高危因素。及时消除支气管内痰液潴留，手术前。

Objective To analyze the risk factors in post thoracotomy pulmonary infection (PTPI). Method 120 patients with PTPI were retrospectively analyzed with regard to age, pulmonary function,preoperative infection, type of endotracheal intubation for anaesthesia,type of operation, use of antibiotics and nursing in perioperation. The data was analyzed using Chi square to determine the interrelationships between multiple variables. Result The morbidity rate of PTPI increased obviously in patients aged over 60 years and the patients with poor pulmonary function(MVV<70%, FEV1%<60%). The same result was observed in patients receiving esophagogastroanastomosis at cervix or above aortic arch,those undergoing widespread mediastinal lymphadenectomy for pulmonary carcinoma, and those having lung infection before operation and cundergoing single tubule type of endotracheal intubation for anaesthesia. Conclusion Senility, poor pulmonary function, high esophagogastroanastomosis, widespread mediastinal lymphadenectomy, preoperative infections of lung and single tubule type endotracheal intubation are the high risk factors of PTPI.To clear sputum in the bronchi and to use effective antibiotics in perioperation are essential to treating and preventing PTPI.