肝切除术后肺部感染危险因素的Meta分析

目的系统评价肝切除术后肺部感染的危险因素。方法检索中国期刊全文数据库(CNKI)、维普中文科技期刊数据库(VIP)、万方数据库、百度学术、PubMed,收集建库至2018年5月公开发表的关于肝切除术后肺部感染影响因素的文献,按纳入标准和排除标准进行筛选,应用RevMan5.3软件进行Meta分析。结果共纳入9篇病例对照研究文献,其中国内文献7篇,国外文献2篇;合计病例组383例,对照组2 030例。Meta分析显示肝切除术后肺部感染的主要危险因素为年龄大、肥胖、有吸烟史、有脑血管意外史、手术时间长(3 h)、术中出血量大(1 000 mL)、术中输血、不预防使用抗菌药物、腹腔引流管留置时间长(10 d)、术后不使用镇痛泵、术后使用呼吸机,各因素合并OR/MD值及95%CI分别为13.55(3.15,23.94)、3.14(1.97,5.01)、3.01(1.50,6.07)、7.08(2.32,21.57)、52.12(8.67,95.58)、326.89(23.06,630.71)、2.68(1.85,3.89)、4.67(2.93,7.45)、1.89(0.77,3.01)、2.98(2.04,4.35)、8.58(4.30,17.12)。结论针对主要危险因素采取相应预防措施,加强呼吸道管理,有利于降低术后肺部感染发病率。

Risk factors for pulmonary infection following hepatectomy: a Meta-analysis

Objective To systematically assess the risk factors for pulmonary infection(PI) following hepatectomy. Methods The published literatures concerning risk factors for PI following hepatectomy from the establishment of database to May 2018 were retrieved from China National Knowledge Infrastructure (CNKI), VIP database (VIP), Wanfang database(Wanfang), Baidu Academic, and PubMed. Literatures were screened according to inclusion and exclusion criteria, Meta-analysis was performed by RevMan 5.3 software. Results A total of 9 case-control studies were included, 7 and 2 were domestic and foreign literatures respectively, 383 and 2 030 were in case group and control group respectively. Meta-analysis showed that the major risk factors for PI in patients following hepatectomy were old age, obesity, history of smoking, history of cerebrovascular accident, long duration of operation (>3 hours), large amount of bleeding during operation(>1 000 mL), intraoperative blood transfusion, without prophylactic use of antimicrobial agents, long duration of indwelling abdominal drainage tube(>10 days), without using analgesic pump after operation, and use of ventilator after operation. The combined OR/MD values and 95%CI of each factor were 13.55(3.15, 23.94), 3.14(1.97, 5.01), 3.01(1.50, 6.07), 7.08(2.32, 21.57), 52.12(8.67, 95.58), 326.89(23.06, 630.71), 2.68(1.85, 3.89), 4.67(2.93, 7.45), 1.89(0.77, 3.01), 2.98(2.04, 4.35), and 8.58(4.30, 17.12) respectively. Conclusion Incidence of PI following hepatectomy can be reduced through taking corresponding preventive measures against the main risk factors and strengthening management of respiratory tract.