食管癌手术围术期肺部感染的高危因素分析及预防

目的探讨食管癌手术围术期发生肺部感染的高危因素及其预防措施。方法回顾性分析2009～2012年广元市中心医院258例食管癌手术患者的临床资料,按食管癌术后是否发生肺部感染将258例食管癌手术患者分为两组,肺部感染组：86例,男62例、女24例,平均年龄65.1（45～84）岁,食管癌手术后均发生肺部感染;对照组：172例,男124例、女48例,平均年龄60.2（43～78）岁,为随机抽取的同期食管癌手术后未发生肺部感染者。比较两组患者的术前肺功能、年龄、吸烟量、吻合口位置、手术出血量、术前、术后其它合并症及管状胃代食管肺部感染发生率的差异,并采用logistic多因素回归分析食管癌手术围术期肺部感染的高危因素。结果单因素分析结果显示,肺部感染组肺功能中重度障碍、吸烟（≥400支/年）、高龄（≥65岁）、喉返神经损伤、围手术期失血量（术中出血＋术后24 h胸腔、腹腔引流量≥1 000 ml）、手术时间≥4 h、术前合并糖尿病的比率均高于对照组（P〈0.05）。Logistic多因素回归分析结果显示,肺功能中重度障碍（P=0.022）、吸烟（≥400支/年,P=0.000）、高龄（≥65岁,P=0.026）、喉返神经损伤（P=0.002）、围手术期失血量（术中出血＋术后24 h胸、腹腔引流量≥1 000 ml,P=0.020）是食管癌患者术后发生肺部感染最主要的危险因素。结论肺功能中-重度障碍、吸烟（≥400支/年）、高龄（≥65岁）、喉返神经损伤、围手术期失血量（≥1 000 ml）是食管癌术后发生肺部感染的高危因素;术前戒烟、加强呼吸功能锻炼、呼吸道准备、严密止血、注意保护喉返神经等措施可预防肺部感染的发生。

Risk Factor Analysis and Prevention of Pneumonia of Patients after Esophagectomy

Objective To explore risk factors of pneumonia of patients after esophagectomy and its preventive measures. Methods Clinical data of 258 patients undergoing esophagectomy in Guangyuan Central Hospital between 2009 and 2012 were retrospectively analyzed. According to whether they had pneumonia after esophagectomy, all the 258 patients were divided into 2 groups. In the pneumonia group, there were 86 patients including 62 males and 24 females with their age of 65.1 （45-84）years, who all had pneumonia after esophagectomy. In the control group, there were 172 patients including 124 males and 48 females with their age of 60.2 （43-78） years, who didn＇t have pneumonia after esophagectomy. Preoperative pulmonary function, age, smoking history, anastomotic location, intraoperative blood loss, pneumonia and other perioperative complications were compared between the 2 groups. Multivariate logistic regression was performed to analyze risk factors of pneumonia after esophagectomy. Results Univariate analysis showed that incidences of moderate or severe pulmonary dysfunction, smoking history （ ≥ 400 cigarettes per year）, old age （ ≥65 years）, laryngeal recurrent nerve injury, perioperative blood loss （ ≥ 1 000 ml）, operation time longer than 4 hours, and preoperative diabetes mellitus of the pneumonia group were significantly higher than those of the control group （P 〈 0.05 ）. Multivariate logistic regression analysis showed that moderate or severe pulmonary dysfunction （P=0.022）, smoking history （≥ 400 cigarettes per year, P=-0.000）, old age （ ≥ 65 years, P=-0.026）, laryngeal recurrent nerve injury （P=0.002）, and perioperative blood loss （ ≥ 1000 ml, P=0.020）were main risk factors of pneumonia after esophagectomy. Conclusions Moderate or severe pulmonary dysfunction, smoking history （ ≥400 cigarettes per year）, old age （ ≥ 65 years）, laryngeal recurrent nerve injury and perioperative blood loss （≥ 1 000 ml） are main risk factors of pneumonia after