口腔颌面部恶性肿瘤患者术后肺部感染的危险因素分析

Analysis of Risk Factors for Postoperative Pulmonary Infection in Patients with Oral and Maxillofacial Malignant Tumors

目的:探讨口腔颌面部恶性肿瘤患者术后肺部感染的相关因素,为临床上预防此类患者术后肺部感染提供策略。方法:选取2016年1月—2018年12月本院颌面外科收治的并行手术治疗的186例口腔颌面部恶性肿瘤患者为研究对象,所有患者采集痰液,筛查病原菌种类并进行药敏分析。根据术后肺部感染情况,列为非感染组和感染组,分析术后肺部感染的相关危险因素。并运用Logistic回归分析,找出口腔颌面部恶性肿瘤术后肺部感染的独立影响因素。结果:所有患者均进行痰培养,39例患者术后肺部感染,感染率为20.97%。其中腭癌患者术后肺部感染率最低,舌癌患者术后肺部感染率最高。39例感染患者痰液共培养出48株病原菌,以革兰氏阴性菌为主,占58.33%,主要为肺炎克雷伯菌和大肠埃希菌;革兰氏阳性菌占37.50%,以金黄色葡萄球菌和表皮葡萄球菌为主。肺炎克雷伯菌和大肠埃希菌对头孢唑林、磺胺甲噁唑和阿莫西林等药物具有较高的耐药性,而表皮葡萄球菌和金黄色葡萄球菌对青霉素的耐药率最高。患者是否吸烟、肺功能(FEV_1、FEV_1/FVC和MVV)、术前白蛋白水平、术中抗生素的使用与否以及住院时间等指标与术后肺部感染的发生具有相关性(P<0.05);Logistic回归分析结果显示,吸烟和FEV_1是影响口腔颌面部恶性肿瘤患者术后肺部感染的独立因素(P<0.05)。结论:术前加强患者营养以改善术前白蛋白值,提高机体免疫力,尽早戒烟,改善患者通气功能,对降低口腔颌面部恶性肿瘤术后肺部感染率具有重要临床价值。

Objective:To Investigatethe risk factors of postoperative pulmonary infection in patients with oral and maxillofacial malignant tumors,and to provide a reference for clinicall prevention of postoperative pulmonary infection in oral and maxillofacial malignant tumors.Methods:A total of 186 patients with oral and maxillofacial malignancies who underwent concurrent surgery in the maxillofacial surgery from January 2016 to December 2018 were enrolled in the study.The infection statusof the patients was collected and the infected patients were screened for pathogens.Patients were divided into infected group and non-infected group according to whether there was infection after operation.To analyze the factors affecting postoperative pulmonary infection.The relevant factors were included in the Logistic regression analysis to find out the independent influencing factors affecting postoperative pulmonary infection.Results:39 patients with oral and maxillofacial malignant tumors had postoperative pulmonary infection with an in fection rate of 20.97%.Among them,the incidence of postoperative lung infection was the highest in patients with tongue cancer,and the rate of postoperative lung infection was the lowest in patients with palate cancer.A total of 48 pathogenic bacteria were cultured from 39 sputum patients,mainly Gram-negative bacteria,accounting for 58.33%,mainly Klebsiel lapneumoniae and Escherichia coli;Gram-positive bacteria accounted for 37.50%,with Staphylococcus aureus and Staphylococcus epidermids.Klebsiella pneumoniae and Escherichia coli have high resistance to cefazolin,sulfamethoxazole and amoxiciillin,while Staphylococcus epidermidis and Staphylococcus aureus have the highest resistance to penicillin.Patients with smoking,lung function(FEV 1,FEV 1/FVC and MVV),preoperative albumin levels,intraoperative antibiotic use,and length of hospital stay were associated with postoperative pulmonary infection(P<0.05).Logistic regression analysis showed that smoking and FEV 1 were independent factors affecting postoperative pulmonary infect ion in patients with oral and maxillofacial malignant tumors(P<0.05).Conclusion:Strengthening patient nutrition before surgery to improve preoperative albumin value,improve immunity,quit smoking as soon as possible and improve ventilation,have important clinical value in reducing postoperative pulmonary infection rate in oral and maxillofacial malignant tumors.