食管癌术后并发肺部感染的相关因素

Related factors of complication with pulmonary infection after esophagectomy

目的探讨食管癌患者术后并发肺部感染的相关因素,为临床预防术后肺部感染的发生、提高手术效果提供参考依据。方法回顾性分析2012至2013年川北医学院附属医院胸外科接受食管癌根治术的215例患者的临床资料,按照术后是否发生肺部感染,将其分为感染组和对照组,其中感染组患者95例,男性73例,女性22例,平均年龄(63.8±7.5)岁;对照组患者120例,男性83例,女性37例,平均年龄(61.7±6.3)岁。利用卡方检验对两组病例的性别、年龄、病变部位、吸烟史、手术持续时间、术后呼吸机辅助呼吸时间及术前并发症进行率的比较,并通过Logistic多因素回归分析方法进一步明确食管癌切除术后并发肺部感染的危险因素。结果卡方检验结果表明,术后肺感染组患者高龄(≥60岁)、肿瘤发生部位、吸烟史(≥20年)、手术持续时间(≥3 h)、术后呼吸机辅助呼吸时间(≥2 h)、术前并发症(糖尿病、COPDⅢ级以上、低蛋白血症)的比重均高于对照组(P均<0.05)。Logistic多因素回归分析表明,年龄≥60岁(χ2=4.201、P=0.04)、烟龄≥20年(χ2=11.204、P=0.001)、病变部位(χ2=12.415、P=0.000)、手术时间≥3 h(χ2=4.28、P=0.045)、术后呼吸机辅助呼吸时间≥2 h(χ2=4.565、P=0.033)、术前并发糖尿病(χ2=7.335,P=0.007)、术前合并低蛋白血症(χ2=4.97、P=0.026)及术前合并COPDⅢ级以上(χ2=5.225、P=0.022)是食管癌术后并发肺部感染的高危因素。结论年龄≥60岁、烟龄≥20年、肿瘤发生部位、手术时间≥3 h、术后呼吸机辅助呼吸时间≥2 h、术前合并糖尿病、低蛋白血症或重度肺功能受损是食管癌切除术后并发肺部感染的高危因素。

Objective To investigate the risk factors of postoperative pulmonary infection, and to provide the basis for the prevention of pulmonary infection and improvement of operation effect. Methods Clinical data of 215 patients undergoing esophagectomy in Thoracic Surgery North Sichuan Medical College Affiliated Hospital between 2012-2013 were analyzed, retrospectively. According to whether they had pneumonia after esophagectomy, a total of 215 patients were divided into two groups. In the pneumonia group, there were 95 patients including 73 males and 22 females with the average age of（63.8 ± 7.5） years. In the control group, there were 120 patients including 83 males and 37 females with the average age of（61.7 ± 6.3） years, who did not have pneumonia after esophagectomy. Gender, age, pathological changes location, smoking history, operation time, postoperation hypoproteinemia and perioperative complictions were compared between the two groups by χ^2 test. Multivariate Logistic regression was performed to analyze the risk factors of pneumonia after esophagectomy. Results The χ^2 test showed that incidences of old ages（≥ 60 years old）, tumor location, smoking history（≥ 20 years）, operation time（≥ 3 hours）, postoperative respiratory machine auxiliary breathing time（≥ 2 hours）, perioperative complictions（diabetes mellitus, COPD Ⅲ, hypoproteinemia） of the pneumonia group were significantly higher than those of the control group（P all 0.05）. Multivariate Logistic regression analysis showed that incidences of age ≥ 60 years old（χ^2 = 4.201, P = 0.04）, smoking history ≥ 20 years（χ^2 = 11.204, P = 0.001）, tumor location（χ^2 = 12.415, P = 0.000）, operation time ≥ 3 hours（χ^2 = 4.28, P = 0.045）,postoperative respiratory machine auxiliary breathing time ≥ 2 hours（χ^2 = 4.565, P = 0.033）, perioperative complicted with diabetes mellitus（χ^2 = 7.335, P = 0.007）. COPD ≥ Ⅲ level（χ^2 = 5.225, P = 0.022）, hypoproteinemia（χ^2 = 4.97, P = 0.026） were the main risk factors of pneumonia after esophagectomy. Conclusions Age ≥ 60 years old, tumor location, smoking history ≥ 20 years, operation time ≥ 3 hours, postoperative respiratory machine auxiliary breathing time ≥ 2 hours, perioperative complicted with diabetes mellitus, with COPD ≥ Ⅲ level, with hypoproteinemia were the main risk factors of pneumonia after esophagectomy.