肺癌根治术后肺部感染的相关因素分析

刘东东; 沈剑; 黄思远; 王海涛

doi:10.16766/j.cnki.issn.1674-4152.001858

肺癌根治术后肺部感染的相关因素分析

doi: 10.16766/j.cnki.issn.1674-4152.001858

浙江省人民医院/杭州医学院附属人民医院心胸外科，浙江杭州 310014

基金项目:

浙江省医药卫生科技计划项目 2020KY009

浙江省基础公益研究计划项目 LY20H010005

详细信息

通讯作者:
王海涛, E-mail: 443292584@qq.com

中图分类号: R734.2 R563.1
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出版历程
- 收稿日期: 2020-07-30
- 网络出版日期: 2022-02-16

Analysis of factors related to pulmonary infection after radical resection of lung cancer

Department of Cardio-thoracic Surgery, Zhejiang Provincial People's Hospital/People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang 310014, China

摘要

摘要: 目的探讨肺癌根治术后肺部感染的相关影响因素，为预防和降低肺癌根治术后肺部感染几率提供方法依据。方法选取2018年2月—2020年2月在浙江省人民医院心胸外科行肺癌根治术的患者82例，根据是否发生肺部感染分为肺部感染组(23例)和非肺部感染组(59例)。收集和整理患者的一般临床资料，分析肺癌根治术后肺部感染的相关影响因素。结果 82例患者术后肺部感染发生率为28.05%。单因素分析结果显示患者的性别、是否伴有高血压、术前肺功能、肺叶切除部位、病理类型、病理分期与术后肺部感染无显著相关性(均P>0.05)；年龄(≥60岁)、切口VAS评分(4~10分)、长期吸烟史、合并慢性阻塞性肺疾病(COPD)、糖尿病(DM)、手术时间(≥3 h)、手术方式(传统开胸手术)、机械通气时间(≥6 h)、胸腔引流管留置时间(≥4 d)与肺部感染密切相关(均P < 0.05)。Logistic多因素分析显示，年龄大(≥60岁)、手术时间长(≥3 h)、合并COPD、DM、手术方式(传统开胸手术)、长期吸烟史、切口VAS评分(4~10分)、胸腔引流管留置时间长(≥4 d)是肺癌根治术患者术后发生肺部感染的独立影响因素(均P < 0.05)。结论肺癌根治术后肺部感染发生率较高，术后发生肺部感染的影响因素较多，其中年龄大(≥60岁)、手术时间长(≥3 h)、合并COPD、DM、手术方式(传统手术)、长期吸烟史、切口VAS评分(4~10分)、胸腔留置引流时间长(≥4 d)是肺癌根治术患者术后发生肺部感染的危险因素，今后应在临床上针对上述危险因素采取积极处理措施，以降低术后肺部感染发生率。
- 肺癌 /
- 肺癌根治术 /
- 肺部感染 /
- 影响因素
Abstract: Objective To investigate the factors influencing pulmonary infection after radical resection of lung cancer. Methods Eighty-two patients who underwent radical resection of lung cancer in Department of Cardio-thoracic Surgery in Zhejiang Provincial People's Hospital/People's Hospital of Hangzhou Medical College were selected from February 2018 to February 2020. Eighty-two cases of lung cancer, according to whether the lung infection can be divided into pulmonary infection (23 cases) and non-pulmonary infection group (59 cases). The general clinical data of the patients were collected. The factors related to lung cancer that affect postoperative pulmonary infection after radical cure were analysed. Results The incidence of postoperative pulmonary infection was 28.05%. Univariate analysis revealed no significant correlation among gender, hypertension, preoperative pulmonary function, lobectomy site, pathological type, pathological stage and postoperative pulmonary infection (all P>0.05). Age (≥60 years old), VAS score of incision (4-10 points), long-term smoking history, combined chronic obstructive pulmonary disease (COPD), diabetes mellitus (DM), operation duratiion (≥3 h), operation method (i.e., traditional thoracotomy), mechanical ventilation time (≥6 h) and indwelling time of thoracic drainage tube (≥4 days) were closely correlated with pulmonary infection (all P < 0.05). Logistic multivariate analysis showed that age (≥60 years old), long operation duration (≥3 h), combined COPD, DM, operation method (traditional thoracotomy), long-term smoking history, VAS score of incision (4-10 points) and long duration of pleural indwelling drainage (≥4 days) were independent influencing factors for postoperative pulmonary infection in patients undergoing radical resection of lung cancer (all P < 0.05). Conclusion The incidence of postoperative pulmonary infection is high in lung cancer patients after radical resection pulmonary infection. The risk factors of postoperative pulmonary infection in patients with lung cancer after radical resection are age (≥60 years old), long operation duration (≥3 h), with COPD, with DM (traditional surgery), surgical way, long-term smoking history, VAS score of incision (4-10 points) and long chest drainage timeline (≥4 days). These risk factors should be paid more attentions so as to reduce the incidence of postoperative pulmonary infection.
- Lung cancer /
- Radical resection of lung cancer /
- Pulmonary infection /
- Influencing factor

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表 1 肺癌根治术后肺部感染相关危险因素的单因素分析[例(%)]

项目	肺部感染组(23例)	非肺部感染组(59例)	χ²值	P值
性别			0.196	0.658
男性	16(69.57)	38(64.41)
女性	7(30.43)	21(35.59)
年龄(岁)			9.122	0.003
≥60	19(82.61)	27(45.76)
<60	4(17.39)	32(54.24)
长期吸烟史			15.322	< 0.001
有	18(78.26)	18(30.51)
无	5(21.74)	41(69.49)
DM			5.213	0.022
有	15(65.22)	22(37.29)
无	8(34.78)	37(62.71)
COPD			7.713	0.005
有	16(69.57)	21(35.59)
无	7(30.43)	38(64.41)
高血压			1.593	0.207
有	13(56.52)	33(55.93)
无	10(43.48)	26(44.07)
肺叶切除部位			1.152	0.316
一侧肺上叶	8(34.78)	18(30.51)
右肺中叶	6(26.09)	23(38.98)
一侧肺下叶	9(39.13)	18(30.51)
切口VAS评分(分)			20.772	< 0.001
0~3分	6(26.09)	47(79.66)
4~10分	17(73.91)	12(20.34)
手术时间(h)			7.781	0.005
≥3	18(78.26)	26(44.07)
< 3	5(21.74)	33(55.93)
机械通气时间(h)			4.322	0.038
≥6	14(60.87)	21(35.59)
<6	9(39.13)	38(64.41)
引流管留置时间(d)			8.081	0.004
≥4	17(73.91)	23(38.98)
<4	6(26.09)	36(61.02)
手术方式			13.724	<0.001
传统开胸手术	15(65.22)	13(22.03)
胸腔镜手术	8(34.78)	46(77.97)
病理类型			0.557	0.455
鳞癌	14(60.87)	41(69.49)
腺癌	9(39.13)	18(30.51)
病理分期			0.679	0.387
Ⅰ期	11(47.83)	25(42.37)
Ⅱ期	8(34.78)	21(35.59)
Ⅲ期	4(17.39)	13(22.03)
术前肺功能(FEV1, L)			0.196	0.658
≥1.5	7(30.43)	21(35.59)
1.0~1.5	16(69.57)	38(64.41)

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表 2 多因素非条件logistic回归分析变量的赋值方法

项目	赋值方法
年龄	≥60岁=1， < 60岁=0
是否伴有DM	有=1，无=0
是否伴有COPD	有=1，无=0
长期吸烟史	有=1，无=0
切口VAS评分	0~3分=1，4~10分=0
手术时间	≥3 h=1， < 3 h=0
机械通气时间	≥6 h=1， < 6 h=0
引流管留置时间	≥4 d=1， < 4 d=0
手术方式	传统开胸手术=1，胸腔镜手术=0

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表 3 肺癌根治术后肺部感染相关危险因素的多因素分析

项目	B	SE	Waldχ²	P值	OR值	95% CI
年龄≥60岁	2.683	0.828	13.893	< 0.001	2.945	3.635~9.957
手术时间≥3 h	1.271	0.533	6.253	0.019	1.525	1.836~4.264
DM	1.169	0.513	6.173	0.027	1.283	1.362~3.838
COPD	1.027	0.482	5.835	0.031	1.079	1.035~3.683
传统开胸手术	2.982	0.965	14.598	< 0.001	3.218	3.875~11.296
长期吸烟史	2.014	0.783	11.798	< 0.001	2.673	2.892~6.736
切口VAS评分(4~10分)	2.275	0.815	12.793	< 0.001	2.796	3.295~8.982
胸腔引流管留置时间≥4 d	1.603	0.712	10.549	< 0.001	2.172	2.563~5.986
机械通气时间≥6 h	0.375	0.086	2.197	0.089	0.691	0.469~1.983

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参考文献(17)

[1]	常涛, 张铸. 肺癌患者术后院内肺部感染的相关因素分析[J]. 中国胸心血管外科临床杂志, 2013, 20(2): 176-180. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXYX201302020.htm
[2]	JEONG H, CH J W, AHN H J, et al. The effect of preventive use of corticosteroids on postoperative complications after esophagectomy: a retrospective cohort study[J]. Sci Rep, 2019, 9(1): 11984. doi: 10.1038/s41598-019-48349-0
[3]	WANG Z, CAI X J, SHI L, et al. Risk factors of postoperative nosocomial pneumonia in stage Ⅰ-Ⅲa lung cancer patients[J]. APJCP, 2014, 15(7): 3071-3074. http://ocean.kisti.re.kr/downfile/volume/apocp/POCPA9/2014/v15n7/POCPA9_2014_v15n7_3071.pdf
[4]	丁丽娜, 程琳芝, 吴晓英. 外科手术后肺部感染的危险因素分析[J]. 现代预防医学, 2018, 45(1): 178-182. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF201801050.htm
[5]	LEE J Y, JINS M, LEE C H, et al. Risk factors of postoperative pneumonia after lung cancer surgery[J]. J Korean Med Sci, 2011, 26(8): 979-984. doi: 10.3346/jkms.2011.26.8.979
[6]	DUPONT G, FLORY L, MOREL J, et al. Postoperative lymphopenia: an independent risk factor for postoperative pneumonia after lung cancer surgery, results of a case-control study[J]. PLoS One, 2018, 13(10): 0205237. http://www.ncbi.nlm.nih.gov/pubmed/30321194
[7]	HONDA M, OBA K, AKIYOSHI T, et al. Development and validation of a prognostic nomogram for colorectal cancer after radical resection based on individual patient data from three large scale phase Ⅲ trials[J]. Oncotarget, 2017, 8(58): 99150-99160. doi: 10.18632/oncotarget.21845
[8]	SIMONSEN D F, SØGAARD M, BOZI I, et al. Risk factors for postoperative pneumonia after lung cancer surgery and impact of pneumonia on survival[J]. Respir Med, 2015, 109(10): 1340-1346. doi: 10.1016/j.rmed.2015.07.008
[9]	张宁宁. 胸外科手术后肺部感染危险因素分析[J]. 中国现代药物应用, 2017, 11(16): 42-43. https://www.cnki.com.cn/Article/CJFDTOTAL-ZWYY201716023.htm
[10]	PAREEK S, TRABOULSI H, ALLARD B, et al. Pulmonary neutrophilia caused by absence of the NF-kB member RelB is dampened by exposure to cigarette smoke[J]. Mol Immunol, 2019, 114: 395-409. doi: 10.1016/j.molimm.2019.08.011
[11]	王战立, 李永茂, 王成虎, 等. 糖尿病患者胃肠道恶性肿瘤术后感染的临床分析[J]. 中华医院感染学杂志, 2015, 25(11): 2551-2553. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHYY201511055.htm
[12]	WANG H, ANTHONY D, SELEMIDIS S, et al. Resolving viral-induced secondary bacterial infection in COPD: a concise review[J]. Front Immunol, 2018, 9: 2345. doi: 10.3389/fimmu.2018.02345
[13]	侯真明, 王保平, 陈允清. 肺癌外科手术后肺部感染的临床分析[J]. 中国药物与临床, 2014, 14(6): 806-807. https://www.cnki.com.cn/Article/CJFDTOTAL-YWLC201406048.htm
[14]	NGUYEN D M, SARKARIA I S, SONG C, et al. Clinical and economic comparative effectiveness of robotic-assisted, video-assisted thoracoscopic, and open lobectomy[J]. J Thorac Dis, 2020, 12(3): 296-306. doi: 10.21037/jtd.2020.01.40
[15]	于竞璟, 刘惠, 邵丽. 手术室护理对降低胸外科手术术后肺部感染率的影响[J]. 继续医学教育, 2015, 29(10): 136-137. https://www.cnki.com.cn/Article/CJFDTOTAL-JYJY201510107.htm
[16]	LI J, QI G, ZHANG X, et al. Is chest tube drainage necessary after subxiphoid thoracoscopic thymectomy[J]. J Cardiovasc Surg, 2020, 15(1): 254-259.
[17]	MAO M, HUGHES R, PAPADIMOS T J, et al. Complications of chest tubes: a focused clinical synopsis[J]. Curr Opin Pulm Med, 2015, 21(4): 376-386. doi: 10.1097/MCP.0000000000000169