老年肺癌患者术后合并下呼吸道感染的相关因素分析

Analysis of risk factors associated with postoperative lower respiratory infections in the elderly patients with lung carcinoma

目的 探讨影响老年肺癌患者术后合并下呼吸道感染的危险因素,并根据研究结果制定相应的防治措施.方法 收集2014年1月至2015年4月期间在上海交通大学附属仁济医院南院进行手术治疗的老年肺癌患者182例,根据术后是否发生下呼吸道感染分为感染组（29例）和对照组（153例）.对可能影响患者术后下呼吸道感染的危险因素进行单因素和多因素Logistic回归分析.结果 单因素结果显示,老年肺癌患者术后并发下呼吸道感染与年龄（f=-3.03,P＜0.01）、吸烟（r=5.69,P=0.02）、血浆白蛋白（￡=2.40,P=0.02）、用力呼气量（FEV）1.0％（=5.85,P＜0.01）、肺癌分期（x2=7.06,P=0.01）、小细胞癌（x2 =5.09,P=0.02）、合并慢性阻塞性肺疾病（COPD）（x2=16.28,P＜0.01）、合并冠心病（x2=10.13,P＜0.01）相关.多因素Logistic回归结果显示,年龄（OR=1.34,95％ CI：1.13 ～ 1.59,x2=11.17,P＜0.01）、吸烟（OR=12.68,95％ CI：2.06 ～ 78.04,x2 =7.50,P=0.01）、FEV1.0％（OR =0.90,95％CI：0.83 ～0.97,x2 =7.76,P=0.01）、鳞状细胞癌（OR=6.88,95％ CI：1.41 ～33.56,x2 =5.70,P=0.02）、合并COPD（OR=12.44,95％CI：1.41 ～ 109.90,x2 =5.15,P=0.02）和合并冠心病（OR=10.61,95％CI：2.25 ～90.50,x2=7.18,P=0.01）是老年肺癌患者术后发生下呼吸道感染的独立危险因素.结论 高龄、有吸烟史、鳞状细胞癌、低FEV1.0％、合并COPD或冠心病的老年肺癌患者术后容易发生下呼吸道感染;应该采取综合有效的防治措施以降低老年肺癌患者术后下呼吸道感染的发生.

Objective To explore the possible risk factors associated with postoperative lower respiratory infections in the elderly patients with lung carcinoma,and to formulate the appropriate preventive strategies according to the results of the study.Methods From January 2014 to April 2015,182 elderly patients with lung carcinoma who were undergoing surgical treatment in Renji Hospital of Shanghai Jiaotong University were collected.All patients were divided into infection group （n =29） and control group （n =153） according to whether occuring postoperative lower respiratory infections or not.The possible risk factors associated with postoperative lower respiratory infections were analyzed by single factor analysis and multivariable Logistic regression model.Results Single factor analysis showed that the postoperative lower respiratory infections of elderly patients with lung carcinoma were associated with age （t =-3.03,P 〈 0.05）,smoking （x2 =5.69,P =0.02）,albumin （t =2.40,P =0.02）,forced expiratory volume （FEV） 1.0% （t =5.85,P 〈 0.05）,lung carcinoma stage （x2 =7.06,P =0.01）,small cell lung cancer （x2 =5.09,P =0.02）,complication with chronic obstructive pulmonary disease （COPD） （x2 =16.28,P 〈0.01） and complication with coronary heart disease （x2 =10.13,P 〈 0.01）.Multivariable Logistic regression analysis showed that age （OR =1.34,95%CI：1.13-1.59,x2 =11.17,P〈0.01）,smoking （OR=12.68,95% CI：2.06-78.04,x2 =7.50,P=0.01）,FEV1.0% （OR =0.90,95% CI：0.83-0.97,x2 =7.76,P =0.01）,squamous-cell carcinoma （OR =6.88,95% CI：1.41-33.56,x2 =5.70,P =0.02）,complication with COPD （OR =12.44,95% CI：1.41-109.90,x2 =5.15,P =0.02） and complication with coronary heart disease （OR =10.61,95% CI：2.25-90.50,x2 =7.18,P =0.01） were independent risk factors for postoperative lower respiratory infections in the elderly patients with lung carcinoma.Conclusion Age,smoking,squamous-cell carcinoma,low value of FEV1.0%,complication with COPD or coronary heart disease can increase the risk of postoperative lower respiratory infections in the elderly patients with lung carcinoma.Comprehensive and effective preventive strategies should be performed to reduce the risk of postoperative respiratory infections.