气道定植菌对肺癌患者术后肺部感染的影响因素分析

Effect of airway colonization bacteria on postoperative pulmonary infection in patients with lung cancer

目的探讨气道定植菌对肺癌患者术后肺部感染的影响因素。方法选取2014年2月-2016年10月于医院接受治疗的102例非小细胞肺癌患者为研究对象,手术前经纤维支气管镜及气管内液进行细菌取样,按照样本中是否有气道定植菌将患者分为试验组54例和对照组48例,其中试验组术前患有气道定植菌,对照组术前检测结果为无气道定植菌。术后对其进行血清肺表面活性蛋白D含量(surfactant protein,SP-D)检测,分析肺癌患者术后并发症情况;采集患者术后咳痰行病原菌分析,并归纳肺癌患者术后肺部感染的影响因素。结果试验组肺部感染率为25.93%(14/54)高于对照组6.25%(3/48)(P=0.024)。试验组中出现乳糜胸1例,皮下气肿2例,肺栓塞1例,声音嘶哑1例,试验组并发症患者共19例;对照组中出现乳糜胸1例,声音嘶哑1例,对照组并发症患者共5例低于试验组(P=0.032);试验组患者术前血清SP-D水平(32.01±5.98)ng/ml高于对照组(P=0.042)。感染患者共培养分离病原菌28株,其中革兰阳性菌15株,革兰阴性菌12株,真菌1株;共检出8株定植菌,其中肺炎克雷伯菌2株,铜绿假单胞菌2株,大肠埃希菌1株;金黄色葡萄球菌1株,肺炎链球菌1株;白假丝酵母1株;高龄、术前有气道定植菌是肺癌患者术后肺部感染的影响因素(P<0.05)。结论气道定植菌会增加肺癌患者术后肺部感染概率,而高龄是导致术后肺部感染的关键因素,临床应重点关注此类患者并采取相应的预防措施。

OBJECTIVE To explore the effect of airway colonization bacteria on postoperative pulmonary infection in patients with lung cancer.METHODS 102 patients with non-small cell lung cancer received treatment in our hospital from Feb.2014 to Oct.2016 were selected as the research objects.Preoperative fiberoptic bronchoscopy and endotracheal fluid bacterial sampling was conducted,and the patients were divided into two groups according to presence of airway colonization bacteria,including 54 cases of patients with preoperative detection of airway colonization bacteria as observation group,and 48 cases of patients without airway colonization bacteria as the control group.Postoperative serum lung surfactant protein D content(surfactant protein,SP-D)was detected,and postoperative complications in lung cancer patients were analyzed.Respiratory tract secretions of patients were collected for pathogens analysis,and the influencing factors of postoperative pulmonary infection in patients with lung cancer were summarized.RESULTS The pulmonary infection rate in the observation group was 25.93%(14/54),significantly higher than that in the control group which was 6.25%(3/48)(P=0.024).There were 1 case of chylothorax,2 cases of subcutaneous emphysema,1 case of pulmonary embolism,1 case of hoarseness and 19 cases of complications in the observation group.1 case of chylothorax,1 case of hoarseness and 5 cases of complications occurred in the control group,with significantly lower incidences than those in the observation group(P=0.032).The preoperative serum SP-D level in the observation group was(32.01±5.98)ng/ml,significantly higher than that of the control group(P=0.042).17 strains of pathogens were co-cultured and isolated from the infected patients,including 15 strains of gram-positive bacteria,12 strains of gram-negative bacteria and 1 strain of fungus.A total of 8 straisn of colonization bacteria were detected,including 2 strains of Klebsiella pneumoniae,2 strains of Pseudomonas aeruginosa,1 strain of Escherichia coli,1 strain of Staphylococcus aureus,1 strain of Streptococcus pneumoniae,and 1 strain of Candida albicans.Advanced age and preoperative airway colonization bacteria were the influencing factors of postoperative pulmonary infection in patients with lung cancer(P<0.05).CONCLUSION Airway colonization bacteria can significantly increase the possibility of pulmonary infection in patients with lung cancer,and age is the key factor leading to high incidence of postoperative pulmonary infection.The clinicians should pay special attention to these patients and take corresponding preventive measures.