Objective To investigate risk factors of postoperative nosocomial pneumonia in patients after lung cancer surgery, and propose corresponding preventive measures. Methods We retrospectively analyzed clinical records of 720 patients who underwent surgical resection for lung cancer in the First Affiliated Hospital of Xinjiang Medical University between June 2003 and June 2012. There were 460 males and 260 females with their average age of 60.37(17 to 83) years. Univariate analysis and multivariate non-conditional logistic regression analysis were performed to investigate independent risk factors of postoperative nosocomial pneumonia in patients after lung cancer surgery. Results Univariate analysis showed that postoperative nosocomial pneumonia was related to 9 risk factors:age eld than 60 years (χ2=26.67, P=0.000), diabetes mellitus (DM, χ2=34.46, P=0.000), chronic obstructive pulmonary disease (COPD, χ2=59.30, P=0.000), long-term history of heavy smoking (χ2=10.40, P=0.001), duration of antacid therapy (χ2=7.69, P=0.006), operation time (χ2=38.12, P=0.000), surgical strategy (χ2=4.22, P=0.040), duration of mechanical ventilation (χ2=21.86, P=0.000), and significant incision pain (χ2=19.69, P=0.000), while preoperative lung function, antibiotic prophylaxis and intraoperative blood loss were not related to postoperative nosocomial pneumonia.Multivariate analysis showed that 8 factors were independent risk factors of postoperative nosocomial pneumonia including age eld than 60 years (χ2=5.43, P=0.020), DM(χ2=8.61, P=0.003), COPD (χ2=9.15, P=0.002), long-term history of heavy smoking (χ2=5.48, P=0.019), long-term antacid therapy (χ2=13.21, P=0.000), operation time (χ2=5.36, P=0.021), duration of mechanical ventilation (χ2=5.72, P=0.017), and significant incision pain(χ2=3.87, P=0.049). Conclusion Patients after lung cancer surgery are susceptible to postoperative nosocomial pneumonia. Proper preventive measures targeting at the characteristics and risk factors of lung cancer patients may reduce the incidence of postoperative nosocomial pneumonia.
Citation:
CHANG Tao,ZHANG Zhu.. Risk Factors of Postoperative Nosocomial Pneumonia after Lung Cancer Surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2013, 20(2): 176-180. doi: 10.7507/1007-4848.20130054
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Copyright © the editorial department of Chinese Journal of Clinical Thoracic and Cardiovascular Surgery of West China Medical Publisher. All rights reserved
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郑康, 王晋芬. 肺癌患者围手术期免疫功能的变化. 肿瘤研究与临床, 2010, 22 (7):492-494.
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2. |
中华医学会呼吸病学分会. 医院获得性肺炎诊断和治疗指南 (草案). 中华结核和呼吸杂志, 1999, 22 (4):201.
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3. |
袁瑾懿, 杨帆. 美国2005《医院获得性肺炎治疗指南》. 中国感染与化疗杂志, 2006, 6 (6):420-423.
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4. |
温昱鹏, 张鹏. 肺癌术后肺感染的相关因素分析. 天津医科大学学报, 2009, 15 (3):411-412, 437.
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5. |
White M, Martin-Loeches I, Lawless MW, et al. Hospital-acquired pneumonia after lung resection surgery is associated with characteristic cytokine gene expression. Chest, 2011, 139 (3):626-632.
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6. |
杜美英. 肺癌术后并发肺部感染的病因分析及护理对策. 中国医学工程, 2012, 20 (2):116, 119.
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7. |
叶琪. 糖尿病合并肺部感染151例临床分析. 内科, 2007, 2 (1):27-29.
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8. |
Glanemann M, Langrehr J, Kaisers U, et al. Postoperative tracheal extubation after orthotopic liver transplantation. Acta Anaesthesiol Scand, 2001, 45 (3):333-339.
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Walsh TJ, Anaissie EJ, Denning DW, et al. Treatment of aspergillosis:clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis, 2008, 46 (3):327-360.
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刘尚国, 赵宝生, 吕靖民, 等. 食管、贲门癌术后感染危险因素研究. 中华医院感染学杂志, 2008, 18 (8):1096-1098.
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11. |
何耀, 林大庆, 石丘玲, 等. 老年人吸烟及戒烟与相关死亡的前瞻性研究. 中华流行病学杂志, 2002, 23 (3):186-189.
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12. |
侯美娜, 陈毓芬. 盐酸氨溴索注射液治疗慢性支气管炎急性发作80例临床疗效观察. 职业与健康, 2010, 26 (12):1422-1423.
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13. |
刘宏, 杨宏, 范书英. 尘肺患者54例的护理. 中国误诊学杂志, 2008, 8 (26):6477-6477.
|
14. |
谢红旗, 柯明耀, 姜燕. 床边纤维支气管镜在危重病人气道管理的应用. 福建医药杂志, 2009, 31 (3):118-119.
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15. |
董礼文, 黄强, 杨勇, 等. 老年肺癌患者术后并发肺部感染的相关因素及治疗. 中华医院感染学杂志, 2011, 21 (9):1767.
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16. |
陈辉, 梁远竹, 罗霞. 肺癌患者术后肺部院内感染原因分析及对策. 中国实用医刊, 2009, 36 (23):36-37.
|
17. |
许广慧, 杭建明. 肺癌合并肺部感染320例临床分析. 临床肺科杂志, 2005, 10 (3):401-402.
|
18. |
骆雪萍, 施善阳. 机械通气肺部感染病原菌变迁及产ESBLs相关因素分析. 中国感染控制杂志, 2005, 4 (4):343-347.
|
19. |
庞灵, 赵航, 李桂杰, 等. 各种侵入性操作与医院获得性肺炎间关系的分析. 中华医院感染学杂志, 2010, 20 (14):2036-2038.
|
20. |
李茜, 孙仁华, 陈敏华. 重症监护病房呼吸机相关肺炎病原学及危险因素分析. 中华医院感染学杂志, 2009, 19 (24):3338-3340.
|
21. |
王翠英, 杨勤, 谢全荣. 4923例住院患者医院感染监测结果分析. 中华医院感染学杂志, 2010, 20 (10):1405-1406.
|
22. |
O′Keefe-McCarthy S, Santiago C, Lau G.Ventilator associated pneumonia bundled strategies:an evidence based practice.Worldviews Evid Based Nurs, 2008, 5 (4):193-204.
|
23. |
张斌杰, 乐涵波, 陈志军, 等. 肺癌手术后呼吸道感染与病理类型相关性的临床分析. 临床肺科杂志, 2008, 13 (6):715-716.
|
24. |
汪道峰, 娄宁, 李小东, 等. 肿瘤重症患者呼吸机相关性肺炎危险因素分析. 中华医院感染学杂志, 2010, 20 (20):3131-3133.
|
25. |
李冬祎, 陈颖, 毕铭华, 等. 外科术后院内感染84例临床分析. 国际外科学杂志, 2010, 37 (2):90-93.
|
26. |
靳海荣, 王领会. 高龄肺癌患者术后院内肺部感染原因分析及护理. 中华医院感染学杂志, 2008, 18 (2):192-193.
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- 1. 郑康, 王晋芬. 肺癌患者围手术期免疫功能的变化. 肿瘤研究与临床, 2010, 22 (7):492-494.
- 2. 中华医学会呼吸病学分会. 医院获得性肺炎诊断和治疗指南 (草案). 中华结核和呼吸杂志, 1999, 22 (4):201.
- 3. 袁瑾懿, 杨帆. 美国2005《医院获得性肺炎治疗指南》. 中国感染与化疗杂志, 2006, 6 (6):420-423.
- 4. 温昱鹏, 张鹏. 肺癌术后肺感染的相关因素分析. 天津医科大学学报, 2009, 15 (3):411-412, 437.
- 5. White M, Martin-Loeches I, Lawless MW, et al. Hospital-acquired pneumonia after lung resection surgery is associated with characteristic cytokine gene expression. Chest, 2011, 139 (3):626-632.
- 6. 杜美英. 肺癌术后并发肺部感染的病因分析及护理对策. 中国医学工程, 2012, 20 (2):116, 119.
- 7. 叶琪. 糖尿病合并肺部感染151例临床分析. 内科, 2007, 2 (1):27-29.
- 8. Glanemann M, Langrehr J, Kaisers U, et al. Postoperative tracheal extubation after orthotopic liver transplantation. Acta Anaesthesiol Scand, 2001, 45 (3):333-339.
- 9. Walsh TJ, Anaissie EJ, Denning DW, et al. Treatment of aspergillosis:clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis, 2008, 46 (3):327-360.
- 10. 刘尚国, 赵宝生, 吕靖民, 等. 食管、贲门癌术后感染危险因素研究. 中华医院感染学杂志, 2008, 18 (8):1096-1098.
- 11. 何耀, 林大庆, 石丘玲, 等. 老年人吸烟及戒烟与相关死亡的前瞻性研究. 中华流行病学杂志, 2002, 23 (3):186-189.
- 12. 侯美娜, 陈毓芬. 盐酸氨溴索注射液治疗慢性支气管炎急性发作80例临床疗效观察. 职业与健康, 2010, 26 (12):1422-1423.
- 13. 刘宏, 杨宏, 范书英. 尘肺患者54例的护理. 中国误诊学杂志, 2008, 8 (26):6477-6477.
- 14. 谢红旗, 柯明耀, 姜燕. 床边纤维支气管镜在危重病人气道管理的应用. 福建医药杂志, 2009, 31 (3):118-119.
- 15. 董礼文, 黄强, 杨勇, 等. 老年肺癌患者术后并发肺部感染的相关因素及治疗. 中华医院感染学杂志, 2011, 21 (9):1767.
- 16. 陈辉, 梁远竹, 罗霞. 肺癌患者术后肺部院内感染原因分析及对策. 中国实用医刊, 2009, 36 (23):36-37.
- 17. 许广慧, 杭建明. 肺癌合并肺部感染320例临床分析. 临床肺科杂志, 2005, 10 (3):401-402.
- 18. 骆雪萍, 施善阳. 机械通气肺部感染病原菌变迁及产ESBLs相关因素分析. 中国感染控制杂志, 2005, 4 (4):343-347.
- 19. 庞灵, 赵航, 李桂杰, 等. 各种侵入性操作与医院获得性肺炎间关系的分析. 中华医院感染学杂志, 2010, 20 (14):2036-2038.
- 20. 李茜, 孙仁华, 陈敏华. 重症监护病房呼吸机相关肺炎病原学及危险因素分析. 中华医院感染学杂志, 2009, 19 (24):3338-3340.
- 21. 王翠英, 杨勤, 谢全荣. 4923例住院患者医院感染监测结果分析. 中华医院感染学杂志, 2010, 20 (10):1405-1406.
- 22. O′Keefe-McCarthy S, Santiago C, Lau G.Ventilator associated pneumonia bundled strategies:an evidence based practice.Worldviews Evid Based Nurs, 2008, 5 (4):193-204.
- 23. 张斌杰, 乐涵波, 陈志军, 等. 肺癌手术后呼吸道感染与病理类型相关性的临床分析. 临床肺科杂志, 2008, 13 (6):715-716.
- 24. 汪道峰, 娄宁, 李小东, 等. 肿瘤重症患者呼吸机相关性肺炎危险因素分析. 中华医院感染学杂志, 2010, 20 (20):3131-3133.
- 25. 李冬祎, 陈颖, 毕铭华, 等. 外科术后院内感染84例临床分析. 国际外科学杂志, 2010, 37 (2):90-93.
- 26. 靳海荣, 王领会. 高龄肺癌患者术后院内肺部感染原因分析及护理. 中华医院感染学杂志, 2008, 18 (2):192-193.