鼻中隔偏曲患者鼻内镜术后肺部感染的临床特点及影响因素分析

Clinical characteristics and influencing factors for pulmonary infections in patients with nasal septum deviation after endoscopic surgery

目的探究鼻中隔偏曲鼻内镜下手术后肺部感染的临床特点及影响因素。方法选取2012年6月-2017年2月医院收治的鼻中隔偏曲并于医院行鼻内镜下手术的患者519例,分析患者的临床资料,探究肺部感染的病原菌及影响因素。结果 519例鼻中隔偏曲行鼻内镜手术患者发生术后感染37例,感染率为7.13%,感染组患者年龄和住院时间与非感染组有明显差异(P<0.05),感染患者主要临床表现为咳嗽、咳痰,比例分别为100.00%、94.59%,影像学检查结果显示病变主要分布在右下肺叶或双下肺叶,主要为单纯浸润性病变,共有24例,占64.86%,病原菌培养结果显示最主要的病原菌为肺炎克雷伯菌,占30.43%,单因素分析表明:年龄≥60岁、糖尿病、侵入性操作、住院时间≥7d、吸烟史、手术时间≥3h、术中出血量≥200ml的患者感染率较高,多因素logistic回归分析显示:高龄、糖尿病、吸烟史、术中出血量大是患者发生术后医院感染的独立危险因素(P<0.05)。结论鼻中隔偏曲鼻内镜手术患者术后主要病原菌为肺炎克雷伯菌,感染与多种危险因素有关,应加强围手术期高危因素管理,降低感染率。

OBJECTIVE To explore the clinical characteristics and influencing factors for pulmonary infections in the patients with nasal septum deviation after endoscopic surgery.METHODS A total of 519 patients with nasal septum deviation who underwent endoscopic sinus surgery from Jun 2012 to Feb 2017 were enrolled in the study,the clinical data of the patients were analyzed,and the species of pathogens causing the pulmonary infections and influencing factors were observed.RESULTS Of the 519 nasal septum deviation patients who underwent the endoscopic surgery,37 had postoperative infections,with the infection rate 7.13%.There were significant differences in age and length of hospital stay between the infection group and the non-infection group(P<0.05).Among the patients with infection,100.00%had cough,and 94.59%had expectoration.The result of imageological examination showed that the lesions were mainly distributed in the lower right lobes or the lower lobes of both lungs,which were mainly characterized by the simple infiltrative lesions,24(64.86%)cases in total.The result of culture of pathogens indicated that Klebsiella pneumoniae was the predominant species of pathogen,accounting for 30.43%.Univariate analysis showed that the incidence of infections was high in the patients with no less than 60 years of age,diabetes mellitus,invasive operation,length of hospital stay no less than 7 days,smoking history,operation duration no less than 3 hours and intraoperative blood loss volume no less than 200 ml.Multivariate logistic regression analysis indicated that the advanced age,diabetes mellitus,smoking history and large volume of intraoperative blood loss were the independent risk factors for the postoperative nosocomial infections(P <0.05).CONCLUSION K.pneumoniae is the predominant species of pathogen isolated from the nasal septum deviation patients after the endoscopic surgery,there are a variety of risk factors for the infections,and it is necessary to strengthen the management of high risk factors during perioperative period so as to reduce the infection rate.