慢性鼻窦炎FESS术后并发肺部感染危险因素分析

目的分析慢性鼻窦炎(CRS)功能性鼻内镜手术(FESS)术后并发肺部感染的危险因素及其病原菌分布特点。 方法选取2019年1月至2021年12月我院收治的CRS行FESS手术1 037例为对象，采用全自动微生物分析患者痰液标本，Logistic回归分析CRS行FESS手术患者并发肺部感染危险因素。 结果1 037例CRS行FESS术后肺部感染78例(7.52%)。主要表现为发热、咳嗽、咳痰，影像学示双肺炎症56例(71.79%)，左肺炎症14例(17.95%) ，右肺炎症8例(10.26%)，右侧胸腔积液16例(22.22%)，左侧胸腔积液20例(27.78%) ，双侧胸腔积液36例(50%) 。痰病原菌培养78例共分离出8种141株病原菌，其中G^－ 86株(60.99%)包括肺炎克雷伯菌42株(29.79%)、铜绿假单胞菌26株(18.44%)、鲍氏不动杆菌18株(12.77%)；G⁺ 45株(31.91%)包括金黄色葡萄球菌19株(13.48%)、表皮葡萄球菌16株(11.35%)、肺炎链球菌10株(7.09%)；真菌10株(7.09%)。Logistic回归分析显示高龄、合并糖尿病、手术时间、呼吸道侵入性操作是发生术后感染的危险因素(P<0.05)。 结论CRS行FESS手术肺部感染病原菌以肺炎克雷伯菌、铜绿假单细胞菌、金黄色葡萄球菌为主，高龄、合并基础疾病、手术时长、呼吸道侵入性操作是影响CRS行FESS手术肺部感染的危险因素，加强围术期高危因素管理，可降低肺部感染发生率。

Analysis of risk factors of pulmonary infection in patients with chronic rhinosinusitis after functional endoscopic sinus surgery

ObjectiveTo analyze the risk factors and pathogen distribution characteristics of pulmonary infection in patients with chronic rhinosinusitis (CRS) after functional endoscopic sinus surgery (FESS). MethodsA total of 1 037 patients with CRS undergoing FESS in our hospital from January 2019 to December 2021 were selected as subjects. The sputum samples were detected by the automatic microorganism analyzer. The pathogens and risk factors of pulmonary infection in patients undergoing FESS for CRS were analyzed using multivariate Logistic regression. ResultsAmong 1 037 patients with CRS undergoing FESS, 78 patients (7.52%) had pulmonary infection. The main clinical manifestations of the infected patients were cough, expectoration and fever. Imaging examination showed that there were 56 cases of bilateral pneumonia (71.79%), 14 cases of left pneumonia (17.95%), 8 cases of right pneumonia (10.26%), 16 cases of right pleural effusion (22.22%), 20 cases of left pleural effusion (27.78%), and 36 cases (50%) of bilateral pleural effusion. The results of pathogen culture showed that 141 strains of 8 pathogens were isolated from 78 patients, including 86 strains (60.99%)of Gram-negative bacteria, 42 strains (29.79%) of Klebsiella pneumoniae, 26 strains (18.44%) of Pseudomonas aeruginosa, 18 strains (12.77%) of Acinetobacter baumannii; 45 strains (31.91%) of Gram-positive bacteria, 19 strains(13.48%) of gold Staphylococcus aureus, 16 strains (11.35%) of Staphylococcus epidermidis, 10 strains(7.09%) of Streptococcus pneumoniae and 10 strains (7.09%) of fungi. The Logistic regression analysis showed that advanced age, diabetes, long operation time and invasive operation on respiratory tract were risk factors for postoperative nosocomial infection (P<0.05). ConclusionThe main pathogens of pulmonary infection in patients with CRS after FESS are Klebsiella pneumoniae, Pseudomonas aeruginosa and Staphylococcus aureus. Advanced age, comorbidity, long operation time, invasive operation on respiratory tract are main factors affecting pulmonary infection in patients with CRS after FESS. The perioperative management of high-risk patients should be strengthened to reduce the risk of pulmonary infection.