食管癌患者术后肺部感染危险因素的系统评价与Meta分析

Risk factors for postoperative pulmonary infection in patients with esophageal cancer:A systematic review and meta-analysis

目的系统评价食管癌患者术后肺部感染的危险因素。方法计算机检索中国知网、万方、维普、中国生物医学文献数据库、PubMed、EMbase、The Cochrane Library,收集有关食管癌患者术后肺部感染危险因素的病例对照研究、队列研究和横断面研究。检索时限从建库至2021年1月。由2名研究者独立进行文献筛选、资料提取和质量评价,采用RevMan 5.3软件和Stata 15.0软件进行Meta分析。结果共纳入20篇文献,包括5409例食管癌患者。纳入研究的质量评分为6~8分。Meta分析结果显示,年龄[MD=1.99,95%CI(0.10,3.88),P=0.04]、年龄≥60岁[OR=2.68,95%CI(1.46,4.91),P=0.001]、吸烟史[OR=2.41,95%CI(1.77,3.28),P<0.001]、糖尿病[OR=2.30,95%CI(1.90,2.77),P<0.001]、慢性阻塞性肺疾病[OR=3.69,95%CI(2.09,6.52),P<0.001]、肺部疾病[OR=2.22,95%CI(1.16,4.26),P=0.02]、开胸手术[OR=1.77,95%CI(1.32,2.37),P<0.001]、手术时间[MD=14.08,95%CI(9.64,18.52),P<0.001]、手术时间>4 h[OR=3.09,95%CI(1.46,6.55),P=0.003]、单肺通气[OR=3.46,95%CI(1.61,7.44),P=0.001]、喉返神经损伤[OR=5.66,95%CI(1.63,19.71),P=0.006]、未使用自控硬膜外镇痛[OR=2.81,95%CI(1.71,4.61),P<0.001]是食管癌患者术后肺部感染的危险因素。结论现有证据表明,年龄、年龄≥60岁、吸烟史、糖尿病、慢性阻塞性肺疾病、肺部疾病、开胸手术、手术时间、手术时间>4 h、单肺通气、喉返神经损伤、未使用自控硬膜外镇痛是食管癌患者术后肺部感染的危险因素。受纳入文献数量和质量限制,本研究结论仍需要更多高质量的研究予以证实。

Objective To systematically evaluate the risk factors for postoperative pulmonary infection in patients with esophageal cancer.Methods CNKI,Wangfang Data,VIP,CBM,PubMed,EMbase,The Cochrane Library were searched from inception to January 2021 to collect case-control studies,cohort studies and cross-sectional studies about risk factors for postoperative pulmonary infection in patients with esophageal cancer.Two researchers independently conducted literature screening,data extraction and quality assessment.RevMan 5.3 software and Stata 15.0 software were used for meta-analysis.Results A total of 20 articles were included,covering 5409 patients of esophageal cancer.The quality score of included studies was 6-8 points.Meta-analysis results showed that age(MD=1.99,95%CI 0.10 to 3.88,P=0.04),age≥60 years(OR=2.68,95%CI 1.46 to 4.91,P=0.001),smoking history(OR=2.41,95%CI 1.77 to 3.28,P<0.001),diabetes(OR=2.30,95%CI 1.90 to 2.77,P<0.001),chronic obstructive pulmonary disease(OR=3.69,95%CI 2.09 to 6.52,P<0.001),pulmonary disease(OR=2.22,95%CI 1.16 to 4.26,P=0.02),thoracotomy(OR=1.77,95%CI 1.32 to 2.37,P<0.001),operation time(MD=14.08,95%CI 9.64 to 18.52,P<0.001),operation time>4 h(OR=3.09,95%CI 1.46 to 6.55,P=0.003),single lung ventilation(OR=3.46,95%CI 1.61 to 7.44,P=0.001),recurrent laryngeal nerve injury(OR=5.66,95%CI 1.63 to 19.71,P=0.006),and no use of patient-controlled epidural analgesia(PCEA)(OR=2.81,95%CI 1.71 to 4.61,P<0.001)were risk factors for postoperative pulmonary infection in patients with esophageal cancer.Conclusion The existing evidence shows that age,age≥60 years,smoking history,diabetes,chronic obstructive pulmonary disease,pulmonary disease,thoracotomy,operation time,operation time>4 h,single lung ventilation,recurrent laryngeal nerve injury,and no use of PCEA are risk factors for postoperative pulmonary infection in patients with esophageal cancer.Due to the limitation of the quantity and quality of included literature,the conclusion of this study still needs to be confirmed by more high-quality studies.