影响肝癌肝部分切除术后患者合并感染发生的独立高危因素

Independent High-risk Factors Affecting the Occurrence of Co-infection in Patients with Liver Cancer after Partial Hepatectomy

目的探讨肝癌肝部分切除术后患者合并感染发生的独立高危因素,针对这些高危因素制定有效的干预对策。方法回顾性分析哈尔滨医科大学附属第一医院自2017年6月至2019年6月收治的肝癌肝部分切除术患者76例的临床资料,按照是否发生感染分为感染组(n=18)与非感染组(n=48),对比感染组与非感染组患者的术前基线资料、术前实验室指标及手术相关指标,后利用多因素logistic回归分析探讨影响肝癌肝部分切除术后患者合并感染发生的独立高危因素。结果感染组与非感染组的性别比例、年龄、合并症(冠心病、高血压)比例、饮酒史比例、吸烟史比例、病灶位置、病灶最大直径相比差异无统计学意义(P>0.05)。在不同水平的白细胞、血小板、凝血酶原时间、总胆红素、谷丙转氨酶及天冬氨酸转氨酶划分条件下,感染组与非感染组患者所占比例差异无统计学意义(P>0.05)。感染组与非感染组相比,白蛋白<35 g/L的患者所占比例较高,组间差异有统计学意义(P<0.05)。感染组与非感染组相比合并症(糖尿病)比例较高,组间差异具有统计学意义(P<0.05)。感染组与非感染组不同水平下术中失血量、术中输血量、术后引流管留置时间的患者所占比例差异无统计学意义(P>0.05)。感染组与非感染组相比手术时间≥300 min、术后发生胆漏的患者所占比例较高,组间差异有统计学意义(P<0.05)。经Logistic多因素分析可见,合并糖尿病、白蛋白水平<35 g/L、手术时间≥300min、术后胆漏发生可作为影响肝癌肝部分切除术后合并感染发生的独立高危因素(P<0.05)。结论合并糖尿病、白蛋白水平<35 g/L、手术时间≥300 min、术后胆漏发生可作为影响肝癌肝部分切除术后合并感染发生的独立高危因素,针对上述因素需要制定有效的干预对策以降低术后感染的发生风险。

Objective To explore and analyze the independent risk factors of co-infection in patients with liver cancer after partial hepatectomy,and to develop effective intervention strategies for these high-risk factors.Methods The clinical data of 76 patients with partial hepatectomy for liver cancer admitted from June 2017 to June2019 in our hospital were retrospectively analyzed.According to whether infection occurred,the infection group was divided into infected group(n=18)and non-infected group(n=48),then we compared the preoperative baseline data,preoperative laboratory parameters and surgical related indicators between infected and non-infected patients,and then used multivariate logistic regression analysis to explore the independent high risk of co-infection in patients with liver cancer after partial resection factor.Results There was no significant difference in the sex ratio,age,proportion of comorbidities(coronary heart disease,hypertension),proportion of drinking history,proportion of smoking history,location of lesions,and maximum diameter of lesions in the infected group and non-infected group(P>0.05).Under different conditions of leukocyte,platelet,prothrombin time,total bilirubin,alanine aminotransferase and aspartate aminotransferase,there was no significant difference between the infected group and the non-infected group(P>0.05).The proportion of patients with albumin<35 g/L was higher in the infected group than in the non-infected group,and the difference between the groups was statistically significant(P<0.05).The proportion of comorbidities(diabetes)was higher in the infected group than in the non-infected group,and the difference between the groups was statistically significant(P<0.05).There was no significant difference in the proportion of patients with blood loss during operation,blood transfusion during operation,and indwelling time of postoperative drainage tube at different levels between the infected group and the non-infected group(P>0.05).Compared with the non-infected group,the infected group had a higher proportion of patients with operation time≥300 min and postoperative bile leakage,and the difference between the groups was statistically significant(P<0.05).Through logistic multivariate analysis,we found that combined diabetes,albumin level<35 g/L,operation time≥300 min,and postoperative bile leakage are the independent high-risk factors that affect the incidence of infection after partial hepatectomy for liver cancer(P<0.05).Conclusion Combining diabetes,albumin level<35 g/L,operation time≥300 min,postoperative biliary leakage can be used as an independent high-risk factor affecting the incidence of infection after partial hepatectomy for liver cancer,and effective intervention strategies need to be formulated to reduce the risk of subsequent infection after operation.