食管癌根治术后合并肺部感染患者的肺功能状况及预后研究

Pulmonary function and prognosis in patients with pulmonary infection after radical resection esophageal cancer

目的探讨食管癌根治术后合并肺部感染患者的肺功能状况及预后情况,为临床诊治提供依据。方法选取2016年1月至2018年12月于西安国际医学中心医院行食管癌根治术后合并肺部感染患者28例为感染组,另选取同期行食管癌根治术后未合并感染患者100例为未感染组。比较两组患者术后肺功能一秒用力呼气容积(FEV1)、用力肺活量(FVC)、FEV1/FVC水平、外周血细胞因子肿瘤坏死因子-α(TNF-α)、白介素-6 (IL-6)、C-反应蛋白(CRP)、白介素-1β(IL-1β)水平,以及并发症发生率和预后情况。结果感染组患者的肺功能FVC、FEV1和FEV1/FVC分别为(1.99±0.53) L、(1.57±0.42) L、(47.32±9.14)%,明显低于未感染组的(2.56±0.69) L、(2.14±0.63) L、(53.19±11.62)%,差异均有统计学意义(P<0.05);感染组和对照组患者的外周血细胞因子IL-6 [(16.38±3.51) ng/L vs (12.27±2.29) ng/L]、TNF-α[(21.71±5.17) ng/L vs (14.29±2.84) ng/L]、CRP [(31.29±7.36) mg/L vs (11.63±2.32) mg/L]、IL-1β[(25.27±5.46) ng/L vs (19.43±3.74) ng/L]比较,观察组明显高于对照组,差异均有统计学意义(P<0.05);感染组患者术后心律失常发生率为14.29%,明显高于未感染组的1.00%,术后住院时间为(18.48±3.64) d,明显长于未感染组的(9.83±2.14) d,差异有统计学意义(P<0.05);未感染组患者术后死亡率为0,明显低于感染组的14.29%,差异有显著统计学意义(P<0.01)。结论食管癌根治术后合并肺部感染可降低患者肺功能水平,对系统性炎症反应具有消极影响,预后不佳,患者死亡率高。

Objective To investigate the pulmonary function and prognosis of patients with pulmonary infection after radical resection of esophageal cancer, and to provide evidence for clinical diagnosis and treatment. Methods A total of 28 patients with pulmonary infection after radical resection of esophageal cancer, who admitted to Xi’an International Medical Center Hospital from January 2016 to December 2018, were selected as the infection group. During the same period, another 100 patients without infection after radical resection of esophageal cancer in our hospital were enrolled as the non-infection group. The one second forced expiratory volume(FEV1), forced vital capacity(FVC), FEV1/FVC, tumor necrosis factor α(TNF-α), interleukin-6(IL-6), C-reactive protein(CRP) and interleukin-1 β(IL-1β) were compared between the two groups. Results The lung function FVC, FEV1, and FEV1/FVC of patients in the infection group were(1.99±0.53) L,(1.57±0.42) L,(47.32±9.14)%, respectively, which were significantly lower than corresponding(2.56±0.69) L,(2.14±0.63) L,(53.19±11.62)% in the non-infection group(all P<0.05);the peripheral blood cytokines IL-6, TNF-α, CRP, IL-1β in the infection group were(16.38±3.51) ng/L,(21.71±5.17) ng/L,(31.29±7.36) mg/L,(25.27±5.46) ng/L, respectively, which were significantly higher than corresponding(12.27 ± 2.29) ng/L,(14.29 ± 2.84) ng/L,(11.63±2.32) mg/L,(19.43±3.74) ng/L in the non-infection group(all P<0.05);the incidence of postoperative arrhythmia in the infection group was 14.29% versus 1.00% in the non-infection group, the postoperative hospital stay in the infection group was(18.48±3.64) days versus(9.83±2.14) days of the non-infection group(all P<0.05);the postoperative mortality rate of patients in the non-infection group was 0, which was significantly lower than 14.29% in the infection group(P<0.01). Conclusion Complicated with pulmonary infection after radical esophageal cancer can reduce the level of lung function in patients with negative effects on systemic inflammatory response, lead to poor prognosis and high mortality.