摘要
目的探讨高龄肺癌根治术患者围术期肺部感染的高危因素及预防措施。方法选取2013年2月至2016年10月间深圳市人民医院收治的153例行肺癌根治术的高龄患者进行回顾性分析,按照有无肺部感染分为感染组(72例)和非感染组(81例)。观察感染组患者感染菌群并比较两组患者的临床资料。结果感染组患者主要感染菌群为革兰氏菌,包括革兰氏阴性菌的肺炎克雷伯菌、鲍曼不动杆菌和革兰氏阳性菌的金黄苏葡萄球菌,分别为23. 6%、16. 7%和12. 5%,部分患者感染菌群为真菌。患者术前肺功能指标中一秒用力呼气容积(FEV1)<65%和每分钟最大通气量(MVV)<60%,术中输血、手术时间≥4h和白蛋白<30g/L与感染有关,差异均有统计学意义(均P <0. 05)。多因素分析显示,FEV1、MVV、术中输血、手术时间和白蛋白是肺部患者术后感染的独立影响因素,差异均有统计学意义(均P <0. 05)。结论 80岁以上高龄肺癌根治术患者围术期肺部感染的高危因素有肺功能差、术中输血、手术时间长和低白蛋白,需对肺部功能、手术条件和术后营养状况等采取措施,减少肺部感染。
Objective To explore the risk factors influencing perioperative pulmonary infection in elderly patients undergoing radical resection for lung cancer and its prevention and control measures. Methods A total of 153elderly patients who underwent radical resection for lung cancer at Shenzhen People's Hospital from February 2013to October 2016were selected and retrospectively analyzed.They were divided into infection group (72patients)and non infection group (81patients)according to the lung condition.The pathogens were observed and the clinical data were compared between the two groups.Results In the infected group,the main pathogens were Klebsiella pneumoniae,a Gram-negative bacterium,Acinetobacter baumannii and Staphylococcus aureus,a Gram positive bacteria (23.6%,16.7%,and 12.5%, respectively).Some patients were infectied with fungai.For preoperative lung function,forced expiratory volume in one second (FEV1)<65%,maximal voluntary ventilation (MVV)<60%,intraoperative blood transfusion,operation time≥4h and albumin<30g/L were significantly associated with the infection(all P<0.05).FEV1,MVV,intraoperative blood transfusion,operative time and albumin were independent factors influencing postoperative infection in patients with lun cancer.Conclusion FEV1,MVV,intraop- erative blood transfusion,operative time and albumin were all risk factors for intraoperative lung infection in patients more than 80years old.Measures focused on pulmonary function,operative condition and postoper- ative nutritional status are needed to reduce the incidence of lung infection.
作者
彭彬
李国锋
许明明
PENG Bin;LI Guo-feng;XU Ming-ming(Department of Thoracic Surgery,Shenzhen People's Hospital,Shenzhen 518000,China;Department of Radiotherapy,Shenzhen People's Hospital,Shenzhen 518000,China)
出处
《中国肿瘤临床与康复》
2018年第12期1435-1438,共4页
Chinese Journal of Clinical Oncology and Rehabilitation
关键词
肺部感染
高龄
围术期
危险因素
预防
Pulmonary infection
Advanced age
Perioperative period
Risk factors
Prevention
