儿童脑干肿瘤切除术术后肺部感染发生情况及相关因素分析

Analysis of pulmonary infection and related factors after craniotomy of brain stem tumor resection in children

目的研究儿童患者(0~16岁)择期行脑干肿瘤切除术术后肺部并发症的发生情况及相关因素。方法2016年1月—2018年6月在首都医科大学附属北京天坛医院神经外科择期在全身麻醉下行脑干肿瘤切除术且年龄为0~16岁的患儿,共计103例。回顾性收集患儿术前、术中、术后相关资料,调查术后肺部并发症的发生情况及相关因素,并建立回归模型。结果103例患儿中,46例发生肺部感染(44.7%),其中16例(34.8%)岀现呼吸衰竭,4例(8.7%)合并肺不张。发生肺部感染的患儿住院时间和住院费用明显高于无肺部感染的患儿。术后肺部感染的可能诱发因素包括:术中出量(单位体重)、尿量(单位体重)、手术时间、延髓肿瘤、术后1 d血清白蛋白值、术后呼吸机支持。使用多因素Logistic回归分析儿童脑干肿瘤切除术术后肺部感染发生率增加的独立危险因素包括:手术时间[比值比(odds ratio,OR)=1.008,95%CI 1.001~1.015],延髓肿瘤(0R=3.312,95%CI 1.096-8.947),术后呼吸机支持(OR=8.042,95%CI 1.485-43.545)。结论患儿接受择期脑干肿瘤切除术后,肺部感染发生率高达44.7%,应予以重视并加强围手术期管理,其中手术时间、延髓肿瘤、术后呼吸机支持是导致术后肺部感染发生率增加的独立危险因素。

Objective To analyze the incidence and related factor of pulmonary infection in child patients(0-16 years)after brainstem tumor resection.Methods A retrospective analysis was conducted on 103 patients who admitted into department of neurosurgery,Beijing Tiantan Hospital,Capital Medical University and underwent brainstem tumor resection from January 2016 to June 2018.The preoperative,intraoperative and postoperative data were collected to explore the incidence of postoperative pulmonary complications and the effects of related factors on pulmonary infection,and establish a regression model.Results A total of 103 patients were enrolled in this study.There were 46 cases of pulmonary infection(44.7%),with respiratory failure in 16 cases(34.8%)and atelectasis in 4 cases(8.7%).The variables associated with postoperative pneumonia included output volume per kilogram,urine volume per kilogram,operation time,medulla oblongata tumor,serum albumin 1d after surgery and postoperative application of ventilators.According to multi-variate Logistic regression analysis,the independent risk factors for pulmonary infection in children after brainstem tumor resection were as follows:operation time[odds ratio(0R)=1.008,95%confidence interval(CI)1.001-1.015],medulla oblongata tumor(OR=3.312,95%CI 1.096-8.947),and postoperative application of ventilators(OR=8.042,95%CI 1.485- 43.545).Conclusions The incidence of pulmonary infection is reaching 44.7%in child patients undergoing brainstem tumor resection.Increasing attention should be paid on perioperative management.Operation time,medulla oblongata tumor,and postoperative application of ventilators are the independent risk factors that result in an increased incidence of pulmonary infections after brainstem surgery.