食管癌患者术后胸腔感染的危险因素研究

Risk factors for postoperative chest infections in esophageal cancer patients

目的调查食管癌术后患者胸腔感染的危险因素,探讨有效的防治措施。方法将2005年1月-2013年1月心胸外科142例食管癌术后患者分为感染组22例与非感染组120例,在严格无菌操作下抽取142例食管癌术后的患者的胸水或胸腔引流管前端3cm进行细菌培养,并详细记录细菌培养结果,前瞻性研究食管癌术后胸腔感染患者的危险因素,进而制定相应的预防措施。结果 142例食管癌术后患者的胸腔感染22例,感染率为15.49%,检出病原菌18株,以金黄色葡萄球菌、大肠埃希菌为主,各占22.22%,铜绿假单胞菌、鲍氏不动杆菌、肺炎克雷伯菌及褪色沙雷菌各占11.11%;经χ2检验,胸腔感染与手术操作时间、术中出血量、住院时间及胸引管留置时间均有显著关系(P<0.001、0.025、0.035、0.022);与患者年龄、性别、肿瘤大小、使用抗菌药物等无关;多因素回归分析显示,手术操作时间、胸腔引流管留置时间是影响食管癌术后胸腔感染的独立危险因素。结论食管癌术后患者胸腔感染与手术操作时间、胸引管留置时间关联密切,手术时间、胸引管留置时间越长,发生胸腔感染的机会就越大,应制定有效预防措施,降低食管癌术后胸腔感染的发生率。

OBJECTIVE To investigate the risk factors for postoperative chest infections in esophageal cancer patients so as to put forward effective prevention measures. METHODS Totally 142 cases of esophageal cancer patients, who underwent surgery in cardiothoracic surgery department from Jan 2005 to Jan 2013, were divided into the infection group with 22 cases and the non-infection group with 120 cases, then the bacterial culture was performed under the aseptic operation for the pleural effusion or fluid of 3cm length of the head of chest drainage tube obtained from the 142 patients, and the result of the bacterial culture was recorded in detail, the risk factors for the chest infections were prospectively studied, and the corresponding prevention measures were proposed. RESULTS Of totally 142 cases of esophageal cancer patients, the chest infections occurred in 22 cases with the infection rate of 15. 49%. A total of 18 strains of pathogens were isolated, among which the Staphylococcus aureus accounted for 22.22 %, the Escherichia coli 22.22 %, the Pseudomonas aeruginosa 11.11%, Acinetobacter baurnannii 11. 11%, the Klebsiella pneumoniae 11. 11%, and Serratia fade 11. 11%. The chi-square test indicated that the chest infections were significantly correlated with the operation duration, intraoperative blood loss, hospitalization duration, and drainage tube indwelling time （P= 〈0. 001,0. 025,0. 035,0. 022）, which were not related to the age ,gender, size of tumor, or use of antibiotics; multivariate regression analysis showed that the operation duration and drainage tube indwelling time were the independent risk factors for the postoperative chest infections. CONCLUSION The postoperative chest infections in the esophageal cancer patients are closely related to the operation duration and drainage tube indwelling time; the longer the operation duration or the drainage tube indwelling time, the higher the incidence of chest infections. It is necessary to formulate effective prevention measures so as to reduce the incidence of postoperative chest infections.