胃癌根治术后肺部感染病原菌及危险因素

Risk factors for pulmonary infection in gastric cancer patients after radical surgery and distribution of pathogens

目的分析胃癌根治术后肺部感染情况、危险因素及病原菌分布。方法收集郑州大学第五附属医院收治的行腹腔镜胃癌根治术胃癌患者143例临床资料,按术后是否发生肺部感染分为感染组(n=27)与非感染组(n=116),筛选肺部感染影响因素;分析肺部感染病原菌分布及耐药情况。结果胃癌患者术后肺部感染率为18.88%;糖尿病、手术时间、置管时间、术后并发症、围术期输血、营养风险为术后肺部感染的危险因素(P<0.05),术前高白蛋白、高血红蛋白、保温措施为保护因素;肺部感染病原菌主要为革兰阴性菌(55.00%),包括肺炎克雷伯菌(25.00%)、大肠埃希菌(22.50%);革兰阴性菌对阿莫西林、头孢唑林、磺胺甲噁唑甲氧苄啶、头孢噻肟耐药率高,对阿米卡星、头孢哌酮舒巴坦、美罗培南耐药率低;主要革兰阳性菌表皮葡萄球菌对青霉素、红霉素耐药率高;金黄色葡萄球菌对青霉素、氨苄西林耐药率高;两者对利奈唑胺、万古霉素耐药率低。结论胃癌患者腹腔镜根治术后肺部感染风险高,与围术期输血、营养状况、合并糖尿病、手术时间、置管时间、术后并发症均有关,病原菌分布以革兰阴性菌感染为主,主要为肺炎克雷伯菌与大肠埃希菌。

OBJECTIVE To investigate the incidence of pulmonary infection in gastric cancer patients after radical surgery,analyze the risk factors and observe the distribution of pathogens.METHODS A total of 143 gastric cancer patients who underwent laparoscopic radical surgery in the Fifth Affiliated Hospital of Zhengzhou University were enrolled in the study and divided into the infection group with 27 cases and the non-infection group with 116 cases according to the status of postoperative pulmonary infection,the clinical data of the patients were collected.The influencing factors for the pulmonary infection were screened out,and the distribution and drug resistance of the pathogens causing the pulmonary infection were observed.RESULTS The incidence of postoperative pulmonary infection of the gastric cancer patients was 18.88%.Diabetes mellitus,operation duration,catheter indwelling time,postoperative complication,perioperative blood transfusion and nutritional risk were the risk factors for the postoperative pulmonary infection(P<0.05),high level of preoperative albumin,high level of hemoglobin and insulation measures were the protective measures.Gram-negative bacteria(55.00%)were dominant among the pathogens causing the pulmonary infection,25.00%of which were Klebsiella pneumoniae,and 22.50%were Escherichia coli.The drug resistance rates of the gram-negative bacteria to amoxicillin,cefazolin,sulfamethoxazole-trimethoprim and cefotaxime were high,while the resistance rates to amikacin,cefoperazone-sulbactam and meropenem were low.Staphylococcus epidermidis was the predominant species of gram-positive bacteria and was highly resistant to penicillin and erythromycin;the drug resistance rates of Staphylococcus aureus to penicillin and ampicillin were high;the drug resistance rates of the two species to linezolid and vancomycin were low.CONCLUSION The gastric cancer patients are at high risk of pulmonary infection after the laparoscopic radical surgery,which is associated with the perioperative blood transfusion,nutrition status,complication with diabetes mellitus,operation duration,catheter indwelling time and postoperative complications.The gram-negative bacteria are dominant among the pathogens causing the infection,K.pneumoniae and E.coli are the predominant species.