CAJ | 학술논문

目的探讨胃癌根治术后肺部感染的主要危险因素.方法采用病例对照分析的方法,回顾性收集湖南省肿瘤医院2010年10月至2014年2月行根治术的765例胃癌患者的病例资料,根据术后是否出现肺部感染分为肺部感染组(n =32,4.2％)和对照组(n=733,95.8％).对两组患者的临床病理资料进行Logistic回归分析.结果与对照组相比,肺部感染组手术时间更长[(245.7±66.7) min与(210.9±47.2)min,P＜0.01],术后转重症监护病房(ICU)比例更高(12.5％与2.9％,P=0.02),且术后住院时间更久[(21.9±24.9)d与(14.2±4.2)d,P＜0.01].单因素分析发现年龄≥60岁、吸烟指数≥400年支、合并糖尿病、合并慢性阻塞性肺病、近端胃或全胃切除术、联合脏器切除、手术时间≥240 min、术中失血量≥300 ml、留置胃管≥5 d、围手术期输血、输血≥3 U、术后输血和术后肺部感染以外其他并发症的发生13个因素与胃癌根治术后肺部感染的发生相关(均P＜0.05).进一步行多因素Logistic回归分析显示合并糖尿病(OR=4.77,95％ CI:1.18～19.23),术后出现肺部感染以外的并发症(OR =3.15,95％CI:1.25 ～7.90),术中出血量≥300 ml(OR=2.63,95％ CI:1.17 ～5.90)和术后留置胃管≥5 d(OR=2.30,95％CI:1.02～5.21)4个因素是胃癌根治术后发生肺部感染的独立危险因素.结论合并糖尿病、术后出现肺部感染以外的并发症,术中出血量≥300 ml和术后留置胃管≥5 d是胃癌根治术后发生肺部感染的独立危险因素,针对这些危险因素进行干预或许可以降低术后肺部感染的发生率.
목적 탐토위암근치술후폐부감염적주요위험인소.방법 채용병례대조분석적방법,회고성수집호남성종류의원2010년10월지2014년2월행근치술적765례위암환자적병례자료,근거술후시부출현폐부감염분위폐부감염조(n =32,4.2％)화대조조(n=733,95.8％).대량조환자적림상병리자료진행Logistic회귀분석.결과 여대조조상비,폐부감염조수술시간경장[(245.7±66.7) min여(210.9±47.2)min,P＜0.01],술후전중증감호병방(ICU)비례경고(12.5％여2.9％,P=0.02),차술후주원시간경구[(21.9±24.9)d여(14.2±4.2)d,P＜0.01].단인소분석발현년령≥60세、흡연지수≥400년지、합병당뇨병、합병만성조새성폐병、근단위혹전위절제술、연합장기절제、수술시간≥240 min、술중실혈량≥300 ml、류치위관≥5 d、위수술기수혈、수혈≥3 U、술후수혈화술후폐부감염이외기타병발증적발생13개인소여위암근치술후폐부감염적발생상관(균P＜0.05).진일보행다인소Logistic회귀분석현시합병당뇨병(OR=4.77,95％ CI:1.18～19.23),술후출현폐부감염이외적병발증(OR =3.15,95％CI:1.25 ～7.90),술중출혈량≥300 ml(OR=2.63,95％ CI:1.17 ～5.90)화술후류치위관≥5 d(OR=2.30,95％CI:1.02～5.21)4개인소시위암근치술후발생폐부감염적독립위험인소.결론 합병당뇨병、술후출현폐부감염이외적병발증,술중출혈량≥300 ml화술후류치위관≥5 d시위암근치술후발생폐부감염적독립위험인소,침대저사위험인소진행간예혹허가이강저술후폐부감염적발생솔.
Objective To explore the major risk factors for pulmonary infection after radical gastrectomy in patients with gastric cancer.Methods From November 2010 to February 2014,a total of 765 patients undergoing radical gastrectomy at our hospital were divided into 2 groups based upon the presence of postoperative pulmonary infection (n =32,4.2％) or not (n =733,95.8％).Their clinicopathological data were retrospectively analyzed by Logistic regressive analysis with a case-control study model.Results Comparing with the control group,the patients had longer surgical duration (245.7 ± 66.7 vs 210.9 ±47.2 min,P ＜0.01),higher rates of requiring intensive care (12.50％ vs 2.86％,P =0.02) and longer postoperative hospital stays (21.9 ± 24.9 vs 14.2 ± 4.2 days,P ＜ 0.01) in the postoperative pulmonary infection group.Univariate Logistic regressive analysis found that age ≥60 years,smoking ≥ 400 year by cigarette,diabetes mellitus,chronic obstructive pulmonary disease,proximal or total gastrectomy,combined organ resection,surgical duration ≥ 240 min,intra-operative blood loss ≥ 300 ml,peri-operative transfusion,transfusion ≥ 3 unit packed red blood cell,post-operative transfusion and post-operative complications other than pulmonary infcctions were associated with postoperative pulmonary infection (all P ＜ 0.05).Further multivariate analysis identified 4 independent risk factors for pulmonary infection after radical gastrectomy,including diabetes mellitus (OR =4.77,95％ CI:1.18-19.23),post-operative complications other than pulmonary infections (OR =3.15,95％ CI:1.25-7.90),intra-operative blood loss ≥ 300 ml (OR =2.63,95％ CI:1.17-5.90) and post-operative nasogastric tube ≥5 days (OR =2.30,95 ％ CI:1.02-5.21).Conclusion Correcting the modifiable risk factors may reduce thc incidence of pulmonary infection and shorten the length of hospital stays and costs after radical gastrectomy in patients with gastric cancer.