胃癌根治术后60岁以上患者肺部感染危险因素分析  

Analysis of risk factors of pulmonary infection in patients over 60 years of age after radical resection for gastric cancer

作　　者：姚震旦[1] 杨宏[1] 崔明[1] 邢加迪[1] 张成海[1] 张楠[1] 陈蕾[1] 刘茂兴[1] 徐凯[1] 谭非[1] 苏向前[1] Yao Zhendan;Yang Hong;Cui Ming;Xing Jiadi;Zhang Chenghai;Zhang Nan;Chen Lei;Liu Maoxing;Xu Kai;Tan Fei;Su Xiangqian(Department IV of Gastrointestinal Cancer Center,Key laboratory of Carcinogenesis and Translational Research(Ministry of Education/Beijing),Peking I nirersity Cancer Hospital&Institute,Beijing 100142,China)

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所胃肠肿瘤中心四病区、恶性肿瘤发病机制及转化研究教育部重点实验室,100142

出　　处：《中华胃肠外科杂志》2019年第2期164-171,共8页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金项目(81672439、81272766、81450028);北京市自然科学基金(7162039);首都卫生发展科研专项(首发2018-2-2153);北京市医院管理局临床医学发展专项(XM201309、ZYLX201701).

摘　　要：目的 探讨60岁以上胃癌患者行胃癌根治术后发生肺部感染的危险因素。 方法 采用病例对照研究的方法,回顾性收集北京大学肿瘤医院胃肠中心四病区2009年4月至2016年12月期间行胃癌根治术的60岁以上373例患者的临床病理资料,采用独立样本t检验(符合正态分布,采用±s表示)和Mann-Whitney U检验[不符合正态分布,采用中位数(四分位数间距)表示]进行计量资料的组间比较;χ^2检验或Fisher精确概率法检验进行计数资料(用例数及百分率表示)组间比较,分析术后出现肺部感染(含术后肺不张)与未出现肺部感染两组患者的临床病理特征,采用logistic回归多因素分析影响胃癌术后肺部感染的危险因素。术后肺部感染定义为:术后患者出现体温升高(>38.0℃)并持续24 h以上;伴咳嗽咳痰,痰细菌培养阳性;胸部影像学检查提示有新近出现的浸润、实变或肺不张。 结果 373例患者中,术后出现肺部感染50例(13.4%,肺部感染组),未出现肺部感染323例(86.6%,无肺部感染组)。肺部感染组患者术前合并基础疾病(包括高血压、糖尿病以及心肺疾病等)39例(78.0%),无肺部感染组为178例(55.1%),两组比较,差异有统计学意义(χ^2=9.325,P=0.002)。术前低白蛋白血症发生率肺部感染组也明显高于无肺部感染组[10.0%(5/50)比3.1%(10/323),χ^2=4.098,P=0.048]。肺部感染组与无肺部感染组相比,全胃切除率[54.0%(27/50)比34.4%(111/323),χ^2=12.501,P=0.002]、术后伤口疼痛率[34.0%(17/50)比11.8%(38/323),χ^2=16.928,P<0.001]、二次手术比率[6.0%(3/50)比0.6%(2/323),χ^2=6.032,P=0.014]以及胃管拔除超过7 d的比率[96.0%(48/50)比84.5%(273/323),χ^2=4.811,P=0.028]均明显升高,术后住院天数亦明显延长[中位数(四分位数间距):16.0(9.5)d比12.0(5.0)d,U=4 275.0,P<0.001]。多因素logistic回归分析显示,术前合并内科基础疾病(OR=4.008,95%CI:1.768~9.086,P=0.001)、腹腔感染(OR=3.164,95%CI:1.075~9.313,P=0.037)Objective To investigate the risk factors of postoperative pulmonary infection(PPI)in patients over 60 years of age with gastric cancer after radical gastrectomy.Methods Clinicopathological data of 373 patients over 60 years of age who underwent radical gastrectomy at Department IV of Gastrointestinal Cancer Center,Peking University Cancer Hospital,from April 2009 to December 2016 were retrospectively collected in this case-control study.The clinicopathological characteristics of patients with postoperative pulmonary infection(including postoperative atelectasis)and those without pulmonary infection were compared.A Student t-test(reported as Mean±SD if data matching normal distribution)or Mann-Whitney U test[reported as median(quartile)if data did not conform to normal distribution]was used to analyze continuous variables.Aχ^2 test or Fisher exact tests(reported as number and percentage)was used for categorical variables.Multivariable logistic regression was used to analyze the risk factors for pulmonary infection after operation of gastric cancer.PPI was defined as postoperative patients with elevated body temperature(>38.0℃)for more than 24 hours;cough and expectoration;positive sputum bacteria culture;recent infiltration,consolidation or atelectasis confirmed by chest imaging examination.Results Among 373 patients,50 cases had PPI(13.4%,PPI group),323 cases had no PPI(86.6%,non-PPI group).There were 39(78.0%)and 178(55.1%)patients with comorbidities(including hypertension,diabetes and cardiopulmonary disease)preoperatively in PPI and non-PPI group,respectively.The difference between two groups was statistically significant(χ^2=9.325,P=0.002).The incidence of preoperative hypoalbuminemia in PPI group was also significantly higher than that in non-PPI group[10.0%(5/50)vs.3.1%(10/323),χ^2=4.098,P=0.048].Compared to non-PPI group,the rate of total gastrectomy[54.0%(27/50)vs.34.4%(111/323),χ^2=12.501,P=0.002],postoperative wound pain[34.0%(17/50)vs.11.8%(38/323),χ^2=16.928,P<0.001],secondary operation[6.0%(

关 键 词：胃肿瘤 60岁以上 肺部感染 术后 因素分析 

分 类 号：R735.2[医药卫生—肿瘤]