老年胃癌腹腔镜根治术后肺部感染的影响因素分析

Influencing factors of pulmonary infection in elderly patients with gastric cancer after laparoscopic surgery

目的探讨老年胃癌(gastric cancer,GC)腹腔镜根治术后肺部感染影响因素。方法选取2020年9月~2023年9月我院腹腔镜根治术老年GC病人228例,依据术后30天内肺部感染情况分为肺部感染组和未感染组。比较两组临床资料,Logistic回归分析病人术后肺部感染的独立危险因素,建立回归风险预测模型,判断模型拟合优度与预测效能。结果228例老年GC病人术后出现肺部感染31例(13.60%)。Logistic回归分析显示,手术时间、术中输血、术后伤口疼痛、营养风险、衰弱均为病人术后肺部感染的独立危险因素(P<0.05)。Hosmer-Lemeshow检验显示,P=0.147,模型构建有效。绘制受试者操作特征ROC曲线发现,模型预测病人术后肺部感染的曲线下面积AUC为0.775,预测敏感度为70.97%,特异度为81.22%。结论手术时间、术中输血、术后伤口疼痛、营养风险、衰弱均为老年GC病人术后肺部感染的独立危险因素(OR分别为1.022、2.607、3.629、2.938、2.789)(P<0.05),据此构建的风险模型预测价值良好。

Objective To investigate the influencing factors of pulmonary infection in elderly patients with gastric cancer(GC)after laparoscopic surgery.Methods A total of 228 elderly patients with GC who underwent laparoscopic radical resection in our hospital from September 2020 to September 2023 were selected.According to the pulmonary infection within 30 days after operation,they were divided into pulmonary infection group and control group.The clinical data of the two groups were compared,the independent risk factors of postoperative pulmonary infection were identified,the regression risk prediction model was established,and the goodness of fit and prediction efficiency of the model were judged.Results There were 31 cases(13.60%)of postoperative pulmonary infection in 228 elderly patients with GC.Logistic regression analysis showed that operation time,intraoperative blood transfusion,postoperative wound pain,nutritional risk and frailty were independent risk factors for postoperative pulmonary infection(P<0.05).Hosmer-Lemeshow test showed that P=0.147,suggesting that the model was effective.The receiver operating characteristic(ROC)curve showed that the area under the curve(AUC)of the model for predicting postoperative pulmonary infection was 0.775,the predictive sensitivity was 70.97%,and the specificity was 81.22%.Conclusion Operative time,intraoperative blood transfusion,postoperative wound pain,nutritional risk and frailty were all independent risk factors for postoperative pulmonary infection in elderly patients with GC(OR were 1.022,2.607,3.629,2.938,2.789,respectively)(P<0.05).The risk model established based on these factors had good predictive value.