胃癌术后肺部感染相关因素的研究进展

Research progress on factors contributing to pulmonary infection after gastric cancer surgery

目的总结胃癌术后肺部感染相关因素的研究进展,以期为医疗决策者及临床实践者有效控制胃癌术后肺部感染发生率、保障医疗安全及提高患者生活质量提供参考。方法回顾近年来国内外关于胃癌术后肺部感染相关因素的研究并做综述。结果肺部感染目前尚无统一的诊断标准。不同国家和地区之间对于胃癌术后肺部感染发生率的报道存在差异。从目前的研究结果看,导致胃癌术后肺部感染的致病菌以革兰阴性菌为主,其中尤以铜绿假单胞菌、大肠埃希菌、鲍氏不动杆菌、肺炎克雷伯菌检出率较高。年龄、吸烟史、术前肺功能、术前实验室指标、术前合并症、术前营养状态、术前虚弱、麻醉、肿瘤位置、手术方式、手术时长、输血、留置胃肠减压管、伤口疼痛等是胃癌术后肺部感染的可能相关因素。结论胃癌术后肺部感染的发生率不低。基于对相关因素的认知,提出有必要开发胃癌术后肺部感染的风险预测模型,以识别高危患者。此外,除常规性针对相关因素采取的干预策略外,以发病机制为切入点,寻找导致胃癌术后肺部感染发生的关键因素是降低胃癌术后肺部感染发生的根本途径。

Obejective To summarize the research progress of risk factors contributing to postoperative pulmonary infection in gastric cancer,so as to provide reference for medical decision-makers and clinical practitioners to effectively control the incidence of postoperative pulmonary infection in gastric cancer,ensure medical safety and improve the quality of life of patients.Method The researches at home and abroad on the factors contributing to pulmonary infection after gastric cancer surgery in recent years were reviewed and analyzed.Results There was currently no uniform diagnostic standard for pulmonary infection.The incidence of postoperative pulmonary infection for gastric cancer varied in the different countries and regions.The pathogenic bacteria that caused postoperative pulmonary infection of gastric cancer was mainly gram-negative bacteria,especially Pseudomonas aeruginosa,Escherichia coli,Acinetobacter boulardii,and Klebsiella pneumoniae.The patient’s age,history of smoking,preoperative pulmonary function,preoperative laboratory indicators,preoperative comorbidities,preoperative nutritional status,preoperative weakness,anesthesia,tumor location,surgical modality,duration of surgery,blood transfusion,indwelling gastrointestinal decompression tube,wound pain,and so on were possible factors associated with postoperative pulmonary infection of gastric cancer.Conclusions The incidence of postoperative pulmonary infection for gastric cancer is not promising.Based on the recognition of related factors,it is proposed that it is necessary to develop a risk prediction model for postoperative pulmonary infection of gastric cancer to identify high-risk patients.In addition to the conventional intervention strategy,taking the pathogenesis as the breakthrough,finding the key factors that lead to the occurrence of postoperative pulmonary infection of gastric cancer is the fundamental way to reduce its occurrence.