非糖尿病胃癌患者手术应激性高血糖对术后感染及预后的影响分析

Postoperative infections of surgical stress hyperglycemia in non-diabetic gastric cancer patients and its effect on prognosis

目的调查非糖尿病胃癌患者手术应激性高血糖对患者术后感染及预后的影响。方法回顾性分析2013年3月-2015年3月行胃癌根治术的401例胃癌患者临床资料、细菌培养结果及血糖水平,采用χ~2检验用于感染单因素分析,COX比例回归模型用于预后分析。结果 401例行胃癌根治术的胃癌患者术后,126例出现应激性高血糖,其中感染78例,感染率为61.9%,而未出现应激性高血糖275例患者中,感染99例,感染率为36.0%,应激性高血糖患者感染率显著高于未出现应激性高血糖患者(P<0.05);78例应激性高血糖感染患者中共分离出病原菌82株,以革兰阴性菌为主占62.2%,革兰阳性菌占37.8%;胃癌根治术后应激性高血糖患者感染与年龄、低蛋白和围术期用抗菌药物呈显著相关性(P<0.05);手术时间、TNM分期和应激性高血糖是影响胃癌根治术后感染患者生存的独立预后因素。结论胃癌根治术后应激性高血糖患者术后感染率较高,以革兰阴性菌感染为主,与患者的年龄、低蛋白和围术期抗菌药物的使用与其密切相关,应激性高血糖是胃癌根治术后感染患者的独立预后因素。

OBJECTIVE To investigate the effect of surgical stress hyperglycemia on postoperative infections in nondiabetic gastric cancer patients,and discuss its effect on prognosis of gastric cancer patients.METHODS From Mar.2013 to Mar.2015,clinical characters,bacterial culture results and blood sugar of 401 gastric patients treated with radical gastrectomy were analyzed retrospectively.x2 test was used for univariate analysis of infections,and COX model was used for prognosis analysis.RESULTS Among 401 gastric patients treated with radical gastrectomy,126 patients occurred stress hyperglycemia,among which 78 were infected,with the infection rate of 61.9%.Among 275 patients without stress hyperglycemia,99 patients were infected,with the infection rate of 36.0%.Infection rate in stress hyperglycemia group was significantly higher than that in non-stress hyperglycemia group （P〈0.05）.From 78 gastric patients treated with radical gastrectomy complicated with stress hyperglycemia,82 strains of pathogenic bacteria were isolated,of which gram-negative bacteria were the most common bacteria,accounting for 62.2 %,and gram-positive bacteria accounted for 37.8 %.The age,low-protein and perioperative antimicrobial drugs were significantly correlated with infection of gastric patients treated with radical gastrectomy complicated with stress hyperglycemia（P〈0.05）.Operation time,TNM stage and stress hyperglycemia were the independent prognostic factors of infected gastric patients treated with radical gastrectomy.CONCLUSION Gastric patients complicated with stress hyperglycemia after radical gastrectomy have high postoperative infection rate,and are mainly infected with gram-negative bacteria,and correlated with age,low-protein and perioperative antimicrobial drugs.Stress hyperglycemia is the independent prognostic factor of infections.