肺癌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 lung cancer patients:A systematic review and meta-analysis

目的系统评价肺癌患者术后肺部感染(postoperative pulmonary infection in patients with lung cancer,PPILC)的危险因素,为临床医师预防PPILC提供理论参考。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和The Cochrane Library数据库,收集分析PPILC危险因素的相关研究。检索时限为2012—2021年。由2名临床医师独自筛选文献并提取数据和评估研究的偏倚风险,交叉核对并达成一致。使用RevMan 5.3软件进行Meta分析。结果共纳入25项研究,其中病例对照研究20项,队列研究1项,横断面研究4项,共包括15129例患者。20项病例对照研究和1项队列研究的纽卡斯尔-渥太华量表评分均≥6分;4篇横断面研究的美国医疗保健研究与质量局(Agency for Healthcare Research and Quality,AHRQ)量表评分≥6分。Meta分析结果显示,PPILC的危险因素包括:(1)患者自身因素(4个):年龄≥60岁、男性、有吸烟史、吸烟指数≥400年支;(2)术前疾病与治疗因素(7个):患有糖尿病、慢性心力衰竭和慢性阻塞性肺疾病、第1秒用力呼气容积与用力肺活量的比值<70%、第1秒用力呼气容积占预测值百分比、术前气道定植菌、术前未规范使用预防性抗生素;(3)术中因素(3个):手术时间≥3 h、行开胸手术、切除肺叶≥2个;(4)术后因素(3个):发生术后疼痛、术后机械通气≥12 h、术后侵入性操作。术前淋巴细胞数量多、术中行系统性淋巴结清扫、TNM分期Ⅰ期和Ⅱ期、实施术后加速康复外科是PPILC的保护性因素(P<0.05)。结论当前研究证据显示多种因素与PPILC发生风险有关。但考虑到纳入文献质量及文献数量等的影响,本研究结果亟待更多高质量的临床研究进一步验证。

Objective To systematically evaluate the risk factors for postoperative pulmonary infection in patients with lung cancer(PPILC),and to provide a theoretical reference for clinicians to prevent the occurrence of PPILC.Methods The databases of CNKI,Wanfang data,VIP,CBM,PubMed,EMbase and The Cochrane Library were searched by computer to collect researches on the risk factors for PPILC.The search period was from 2012 to 2021.Two clinicians independently screened literature and extracted data and assessed studies for risk of bias,cross-checked and agreed.Meta-analysis was performed using RevMan 5.3 software.Results A total of 25 studies were included,including 20 case-control studies,1 cohort study,and 4 cross-sectional studies,covering 15129 patients.Twenty case-control studies and 1 cohort study had Newcastle-Ottawa Scale(NOS)scores≥6 points,and 4 cross-sectional studies had the Agency for Health Care Quality and Research(AHRQ)scale scores≥6 points.The results of meta-analysis showed that the risk factors for PPILC included:(1)4 patient's own factors:age≥60 years,male,smoking history,smoking index≥400;(2)7 preoperative factors:suffering from diabetes,chronic heart failure and chronic obstructive pulmonary disease,the ratio of forced expiratory volume in 1 second to forced expiratory volume<70%,the ratio of forced expiratory volume in 1 second to the predicted value,preoperative airway colonization,non-standard use of prophylactic antibiotics before surgery;(3)3 intraoperative factors:operation time≥3 h,thoracotomy,the number of resected lobe≥2;(4)3 postoperative factors:postoperative pain,postoperative mechanical ventilation≥12 h,postoperative invasive operation.Large number of preoperative lymphocyte,intraoperative systematic lymph node dissection,TNM stageⅠandⅡ,and enhanced recovery after surgery were protective factors for PPILC.Conclusion The current research evidence shows that multiple factors are associated with the risk of PPILC.However,considering the influence of the quality and quantity of the included literature,the results of this study urgently need to be further verified by more high-quality clinical studies.