胃癌术后肺部感染病原菌、危险因素及相关预测价值

Pathogens isolated from gastric cancer patients with postoperative pulmonary infection,risk factors and related predictive values

目的探讨胃癌术后肺部感染病原菌、危险因素及相关预测价值。方法选择2016年10月-2022年5月漯河医学高等专科学校第二附属医院收治的212例胃癌切除术后患者为研究对象,根据术后是否并发肺部感染分为感染组36例、非感染组176例。收集患者临床资料及术前、术后24 h实验室指标,感染组患者分析病原菌分布情况;采用多因素Logistic回归分析影响胃癌术后感染发生的因素,并采用受试者工作特征(ROC)曲线分析术后24 h实验室指标的预测价值。结果36份痰液样本共检出68株病原菌,其中革兰阴性菌46株,占67.65%,革兰阳性菌26株,占29.41%,真菌2株,占2.94%。多因素Logistic回归分析显示:糖尿病,手术时间及置管时间是胃癌术后肺部感染发生的危险因素(P<0.05)。术后24 h白蛋白(Alb)、血红蛋白(Hb)、C-反应蛋白(CRP)、降钙素原(PCT)联合预测的曲线下面积为0.884,灵敏度为90.33%,特异度为86.54%。结论胃癌术后肺部感染以革兰阴性菌感染为主,糖尿病、手术时间及置管时间可以增加术后肺部感染风险,术后24 h Alb、Hb、CRP、PCT联合检测对术后肺部感染发生有较高的预测价值。

OBJECTIVE To explore the distribution of pathogens isolated from gastric cancer patients with postoperative pulmonary infection and analyze the risk factors and related predictive values.METHODS Totally 212 gastric cancer patients who received gastrectomy in the Second Affiliated Hospital of Luohe Medical College from Oct 2016 to May 2022 were recruited as the research subjects and were divided into the infection group with 36 cases and the non-infection group with 176 cases according to the status of postoperative pulmonary infection.The clinical data and the laboratory test indexes before surgery and after surgery for 24 hours were collected.The distribution of pathogens isolated from the patients of the infection group was observed,multivariate logistic regression analysis was performed for influencing factors for the postoperative infection in the gastric cancer patients,and the predictive values of the laboratory test indexes 24 hours after surgery were analyzed by means of receiver operating characteristic(ROC)curves.RESULTS Totally 68 strains of pathogens were isolated from 36 sputum specimens,46(67.65%)of which were gram-negative bacteria,26(29.41%)were gram-positive bacteria,and 2(2.94%)were fungi.Multivariate logistic regression analysis showed that diabetes mellitus,operation duration and catheter indwelling time were the risk factors for the postoperative pulmonary infection in the gastric cancer patients(P<O.05).The area under curve(AUC)of the joint detection of albumin(Alb),hemoglobin(Hb),C-reactive protein(CRP)and procalcitonin(PCT)24 hours after surgery was 0.884 in prediction of the postoperative pulmonary infection,with the sensitivity 90.33%,the specificity 86.54%.CONCLUSION The gram-negative bacteria are dominant among the pathogens isolated from the gastric cancer patients with postoperative pulmonary infection.The diabetes mellitus,operation duration and catheter indwelling time may increase the risk of postoperative pulmonary infection,and the joint detection of Alb,Hb,CRP and PCT 24 hours after surgery has high value in prediction of the postoperative pulmonary infection.