2015-2019年398例老年大肠癌患者术后肺部感染情况及危险因素  

Prevalence and risk factors for postoperative pulmonary infection in 398elderly patients with colorectal cancer from 2015to 2019

作　　者：庄丽红 董扬扬[1] 李新宇 李梅君 蔡禾辉 ZHUANG Li-hong;DONG Yang-yang;LI Xin-yu;LI Mei-jun;CAI He-hui(Quanzhou First Hospital,Quanzhou,Fujian 362000,China)

机构地区：[1]泉州市第一医院胃肠外科,福建泉州362000

出　　处：《中华医院感染学杂志》2021年第17期2702-2706,共5页Chinese Journal of Nosocomiology

基　　金：福建省卫生计生委青年科研基金资助项目(2017-2-69)。

摘　　要：目的探讨2015年-2019年老年大肠癌患者术后肺部感染情况及危险因素分析。方法选择2015年1月-2019年12月泉州市第一医院胃肠外科收治的398例老年大肠癌手术患者作为研究对象,记录患者术后肺部感染情况,评估手术前后血清因子降钙素原(PCT)、C-反应蛋白(CRP)、白细胞介素-6(IL-6)、IL-1、IL-4、IL-8、IL-10和肿瘤坏死因子-α(TNF-α)水平变化,采用受试者工作特征(ROC)曲线评估血清学检测诊断患者术后肺部感染的最佳临界值,分析术后肺部感染的危险因素。结果398例老年大肠癌患者术后肺部感染64例,总感染率16.08%,肺部感染率总体呈下降趋势,但年度比较差异无统计学意义(χ^(2)=1.532,P=0.821);肺部感染组与非肺部感染组术前PCT、CRP、IL-6、TNF-α、IL-1、IL-4、IL-8、IL-10比较差异均无统计学意义,术后3d肺部感染组PCT、CRP、IL-6、TNF-α、IL-1、IL-4、IL-8、IL-10水平均高于非肺部感染组(P<0.05);Logistic回归方程分析显示:年龄>75岁、开腹手术、手术时间>3.5h、术后PCT>1.13ng/ml、术后TNF-α>33.10ng/L、术后IL-6>145.32ng/L、术后IL-1β>8.57ng/L均是老年大肠癌患者术后发生肺部感染的危险因素(P<0.05)。结论术后早期血清学检测可作为老年大肠癌患者肺部感染的临床预测肺部感染的指标,且高龄、开腹手术、手术时间过长者均易发生肺部感染,临床应针对高危人群给予相应防控措施。OBJECTIVE To explore the prevalence and risk factors for postoperative pulmonary infection in elderly patients with colorectal cancer from 2015to 2019.METHODS Totally 398elderly patients with colorectal cancer who were treated in gastrointestinal surgery department of Quanzhou First Hospital from Jan 2015to Dec 2019were recruited as the study subjects,the prevalence rates of postoperative pulmonary infection were recorded,the changes of levels of serum procalcitonin(PCT),C-reactive protein(CRP),interleukin-6(IL-6),IL-1,IL-4,IL-8,IL-10and tumor necrosis factor-α(TNF-α)were evaluated before and after surgery,the optimal cutoff value of the serologic indexes in diagnosis of postoperative pulmonary infection was assessed by means of receiver operating characteristic(ROC)curve,and the risk factors for the postoperative pulmonary infection were analyzed.RESULTS Among the 398elderly patients with colorectal cancer,64had postoperative pulmonary infection,with the total infection rate 16.08%;the incidence of pulmonary infection showed a declining trend,but there was no significant difference between 2015and 2019(χ^(2)=1.532,P=0.821).There were no significant differences in PCT,CRP,IL-6,TNF-α,IL-1,IL-4,IL-8and IL-10 between the pulmonary infection group and the non-pulmonary infection group before the surgery;the levels of PCT,CRP,IL-6,TNF-α,IL-1,IL-4,IL-8and IL-10of the pulmonary infection group were significantly higher than those of the non-pulmonary infection group after the surgery for 3days(P<0.05).Logistic regression analysis showed that the more than 75years of age,laparotomy,operation duration more than 3.5h,postoperative PCT more than 1.13ng/ml,postoperative TNF-αmore than 33.10ng/L,postoperative IL-6more than 145.32ng/L and postoperative IL-1βmore than 8.57ng/L were the risk factors for the postoperative pulmonary infection in the elderly patients with colorectal cancer(P<0.05).CONCLUSION Postoperative serological test indexes can be used for clinical prediction of pulmonary infection in the elderly patie

关 键 词：大肠癌手术 老年 肺部感染 流行病学 血清学检测 危险因素 

分 类 号：R563.1[医药卫生—呼吸系统]