喉癌射频消融术后气管切开病人下呼吸道感染的影响因素分析

Main factors of lower respiratory tract infection in patients with tracheotomy after radiofrequency ablation of laryngeal cancer

目的探讨喉癌病人在射频消融术后气管切开下呼吸道感染的主要影响因素。方法选取北京大学深圳医院2012年6月至2016年6月喉癌病人行射频消融术后气管切开病人80例。留取感染病人下呼吸道分泌物分离培养细菌,对细菌采用生物鉴定系统进行鉴定。综合分析下呼吸道感染病人的主要因素并采取有效的预防措施。结果80例病人中发生下呼吸道感染的为11例,无下呼吸道感染为69例,感染率为13.75%。11例病人下呼吸道感染的分泌物细菌分离出23株,其中革兰阴性菌15株占65.21%,革兰阳性菌6株26.09%,真菌2株占8.7%;单因素分析及多因素logistic回归分析显示,手术时间[≥3 h感染者12.73%(7/55),无感染者82.27%(48/55)]、术中出血量[≥400 mL感染者16.28%(7/43),无感染者83.72%(36/43)]、术后少量出血[<50 mL感染者26.67%(4/15),无感染者73.33%(11/15)]、高血糖[空腹血糖≥8.0 mmol/L感染者27.27%(9/33),无感染者72.73%(24/33)]、伴有肺部疾病[感染者20.59%(7/34),无感染者79.41%(27/34)]、抗菌药物的使用[感染者27.59%(8/29),无感染者72.41%(21/29)]、呼吸机的使用[感染者36.36%(8/22),无感染者63.64%(14/22)]是引起射频消融术后气管切开下呼吸道感染的危险因素。术后随访3年至2019年6月,80例病人中,发生过下呼吸道感染病人肿瘤复发者为1例,占9.09%;未发生下呼吸道感染病人肿瘤复发10例,占14.49%。结论手术时间、术中出血量、术后少量出血、高血糖、伴有肺部疾病、抗菌药物的使用及呼吸机的使用是引起射频消融术后气管切开下呼吸道感染的危险因素,对相关病人应采取有效的预防措施,从而减少下呼吸道感染的发生。

Objective To investigate the main influencing factors of lower respiratory tract infection in patients with laryngeal carcinoma following tracheotomy after radiofrequency ablation.Methods From June 2012 to June 2016,80 patients with laryngeal cancer underwent tracheotomy after radiofrequency ablation in Peking University Shenzhen hospital.Bacteria were isolated from the lower respiratory tract secretions of infected patients and identified by biological identification system.Tthe main factors of patients with lower respiratory tract infection were analyzed and effective preventive measures were taken.Results Among the 80 patients,11 had lower respiratory tract infection,69 had no lower respiratory tract infection,and the infection rate was 13.75%.A total of 23 strains of bacteria were isolated from the secretions of 11 patients with lower respiratory tract infection,including 15 strains of Gram-negative bacteria(65.21%),6 strains of Gram-positive bacteria(26.09%)and 2 strains of fungi(8.7%).Univariate analysis and multivariate logistic regression analysis showed that the operation time[≥3 hours,12.73%(7/55)of the patients with infection,82.27%(48/55)of the patients without infection],intraoperative blood loss[≥400 ml,16.28%(7/43)of the patients with infection,83.72%(36/43)of the patients without infection],a small amount of postoperative blood loss[<50 mL,26.67%(4/15)of patients with infection and 73.33%(11/15)of patients without infection],hyperglycemia[fasting blood glucose≥8.0 mmol/L,27.27%(9/33)of patients with infection,72.73%(24/33)of patients without infection],associated with pulmonary disease[20.59%(7/34)of the infected and 79.41%(27/34)of the infected],the use of antibiotics[27.59%(8/29)of the infected,72.41%(21/29)without infection],the use of ventilator[36.36%(8/22)with infection and 63.64%(14/22)without infection]were the risk factors for lower respiratory tract infection after radiofrequency ablation.Conclusion Operation time,intraoperative blood loss,postoperative small amount of blood loss,hyperglycemia,accompanied by lung disease,the use of antibiotics and ventilator are the risk factors of lower respiratory tract infection after radiofrequency ablation tracheotomy.Effective preventive measures should be taken for related patients to reduce the incidence of lower respiratory tract infection.