开胸食管癌根治术后患者肺部感染的危险因素及病原学分析

Risk factors and etiological analysis of pulmonary infection in esophageal carcinoma patients after open esophagectomy

目的探讨开胸食管癌根治术后患者肺部感染的危险因素及病原菌分布。方法选择2015年2月至2016年4月于林州市人民医院行开胸食管癌根治术患者158例,根据患者术后是否发生肺部感染分为肺部感染组和非肺部感染组,比较2组患者的临床资料,对影响术后肺部感染的危险因素进行单因素与多因素logistic回归分析,并分析主要病原菌的分布情况。结果 158例患者中,术后出现肺部感染54例(肺部感染组),无肺部感染104例(非肺部感染组),肺部感染率为34.18%(54/158)。单因素分析显示,患者的年龄、糖尿病、慢性阻塞性肺疾病(COPD)、吸烟史及手术时间与开胸食管癌根治术后患者发生肺部感染有关(P<0.05),但患者的性别、高血压、冠状动脉粥样硬化性心脏病、术前肺功能、病理分期及术中出血量与患者发生肺部感染无关(P>0.05)。Logistic回归分析显示,年龄>60岁、糖尿病、吸烟史、COPD、手术时间>4 h是开胸食管癌根治术后患者发生肺部感染的独立危险因素(P<0.05)。54例肺部感染患者中,48例痰培养阳性,共培养出致病菌70株,其中真菌29株,革兰阳性菌10株,革兰阴性菌31株。结论开胸食管癌根治术后患者肺部感染的危险因素较多,高龄、糖尿病、COPD、吸烟史及手术时间长是其独立危险因素;肺部感染的病原菌分布依次为革兰阴性菌、真菌和革兰阳性菌。临床应针对术后肺部感染的危险因素及病原学特点,制定相应的防治措施,合理选择抗菌药物,以有效预防和治疗肺部感染。

Objective To investigate the risk factors and the distribution of pathogenic bacteria of pulmonary infection in esophageal carcinoma patients after open esophagectomy.Methods A total of 158 patients who underwent open esophagectomy in the People＆#39;s Hospital of Linzhou City from February 2015 to April 2016 were selected.The patients were divided into pulmonary infection group and non pulmonary infection group according to whether pulmonary infection occurred in the patients after operation.The clinical data were compared between the two groups,the risk factors for postoperative pulmonary infection were analyzed by single factor analysis and multivariate logistic regression analysis,and the distribution of main pathogenic bacteria was analyzed.Results Among the 158 patients,pulmonary infection occurred in 54 patients （pulmonary infection group）,and pulmonary infection didn＆#39;t occurred in 104 patients（non pulmonary infection group）,the pulmonary infection rate was 34.18% （54/158）.Single factor analysis showed that the age,diabetes mellitus,chronic obstructive pulmonary disease （COPD）,smoking history and operation time were associated with pulmonary infection in patients after open esophagectomy （P 〈 0.05）;but the gender,hypertension,coronary atherosclerotic heart disease,preoperative lung function,pathological stage and intraoperative blood loss were not associated with pulmonary infection（P 〉0.05）.Logistic regression analysis showed that over 60 years old,diabetes mellitus,smoking history,COPD and operation time more than four hours were the independent risk factors for pulmonary infection in patients after open esophagectomy（P 〈 0.05）.Among the 54 patients with pulmonary infection,the sputum culture was positive in 48 cases,and 70 strains of pathogenic bacteria were cultured,including 29 fungal strains,10 strains of gram positive bacteria,and 31 strains of gram negative bacteria.Conclusion There are many risk factors for pulmonary infection in patients after open esophagectomy.The old age,diabetes mellitus,COPD,smoking history and operation time are the independent risk factors for pulmonary infection.The pathogenic bacteria of pulmonary infection are gram negative bacteria,fungi and gram positive bacteria in turn.In order to prevent and treat the pulmonary infection,we should set up the corresponding prevention and cure measures and reasonably choose the antibacterials according to the risk factors and pathogenic characteristics of postoperative pulmonary infection.