胃癌患者术后感染的危险因素
|
摘要
目的探讨胃癌患者术后感染的危险因素,为感染的预防与控制提供依据。方法回顾性调查甘肃省人民医院2012—2018年收治并行胃癌根治术的患者,自行设计调查表,查阅患者病历资料,调查患者基本特征、手术相关情况、感染情况等。按照患者是否发生术后感染分为感染组与非感染组,比较临床参数进行术后感染危险因素分析。结果共收治行胃癌根治术患者427例,感染组60例,非感染组367例。术后感染发病率为14.05%,感染类型主要为呼吸道感染,占41.67%。60例患者分离出63株病原菌,主要为革兰阳性菌(34株,占53.97%)。革兰阳性菌中主要为草绿色链球菌(19株),并检出5株耐甲氧西林金黄色葡萄球菌(MRSA)。60例术后感染患者中,单一病原菌感染患者44例(73.33%),两种病原菌感染患者9例(15.00%),三种病原菌感染患者7例(11.67%)。单因素分析结果表明,吸烟、消化性溃疡、切除部位、术前住院时间、手术时间、术后卧床时间、静脉置管时间和总住院时间是胃癌患者术后感染的影响因素(均P<0.05)。logistic回归分析结果表明,有消化性溃疡基础疾病史[OR=2.577,95%CI(1.193～5.568)]和手术前住院时间长[OR=2.227,95%CI(1.079～4.599)]是胃癌患者术后感染的独立危险因素。结论该院胃癌患者术后感染的发病率较高,医务人员可针对其相关危险因素实施有效的预防与控制措施,尤其是术前消化性溃疡基础疾病及术前住院时间的控制。
Objective To explore risk factors for postoperative infection in patients with gastric cancer,and provide evidence for prevention and control of infection.Methods A retrospective survey was conducted among patients with gastric cancer who underwent radical gastrectomy in Gansu Provincial Hospital from2012 to 2018,survey was conducted with a self-designed questionnaire,patients' medical records were reviewed,basic characteristics of patients,operation-related conditions,infection status and so on were surveyed.Patients were divided into infection group and non-infection group according to whether they had postoperative infection or not,clinical parameters were compared and risk factors for postoperative infection were analyzed.Results A total of 427 patients underwent radical gastrectomy,60 in infection group and 367 in non-infection group.Postoperative infection rate was 14.05%,respiratory tract infection was the main infection,accounting for 41.67%.60 patients were isolated 63 strains of pathogenic bacteria,mainly gram-positive bacteria(n=34,53.97%).Gram-positive bacteria were mainly Streptococcus viridans(n=19),and 5 strains of methicillin-resistant Staphylococcus aureus(MRSA)were also isolated.Among 60 patients with postoperative infection,44(73.33%)were infected with single pathogen,9(15.00%)with two pathogens and 7(11.67%)with three pathogens.Univariate analysis showed that smoking,peptic ulcer,resection site,preoperative hospital stay,duration of operation,postoperative bed rest time,duration of venous catheterization and total hospital stay were influencing factors for postoperative infection in patients with gastric cancer(all P<0.05).Logistic regression analysis showed that history of underlying diseases of peptic ulcer(OR,2.577[95%CI,1.193-5.568])and long duration of hospital stay before operation(OR,2.227[95%CI,1.079-4.599])were independent risk factors for postoperative infection in patients with gastric cancer.Conclusion Incidence of post-operative infection in patients with gastric cancer in this hospital is high,health care workers can take effective preventive and control measures against the related risk factors,especially control of underlying diseases of peptic ulcer before operation and pre-operative hospital stay.
Objective To explore risk factors for postoperative infection in patients with gastric cancer,and provide evidence for prevention and control of infection.Methods A retrospective survey was conducted among patients with gastric cancer who underwent radical gastrectomy in Gansu Provincial Hospital from2012 to 2018,survey was conducted with a self-designed questionnaire,patients' medical records were reviewed,basic characteristics of patients,operation-related conditions,infection status and so on were surveyed.Patients were divided into infection group and non-infection group according to whether they had postoperative infection or not,clinical parameters were compared and risk factors for postoperative infection were analyzed.Results A total of 427 patients underwent radical gastrectomy,60 in infection group and 367 in non-infection group.Postoperative infection rate was 14.05%,respiratory tract infection was the main infection,accounting for 41.67%.60 patients were isolated 63 strains of pathogenic bacteria,mainly gram-positive bacteria(n=34,53.97%).Gram-positive bacteria were mainly Streptococcus viridans(n=19),and 5 strains of methicillin-resistant Staphylococcus aureus(MRSA)were also isolated.Among 60 patients with postoperative infection,44(73.33%)were infected with single pathogen,9(15.00%)with two pathogens and 7(11.67%)with three pathogens.Univariate analysis showed that smoking,peptic ulcer,resection site,preoperative hospital stay,duration of operation,postoperative bed rest time,duration of venous catheterization and total hospital stay were influencing factors for postoperative infection in patients with gastric cancer(all P<0.05).Logistic regression analysis showed that history of underlying diseases of peptic ulcer(OR,2.577[95%CI,1.193-5.568])and long duration of hospital stay before operation(OR,2.227[95%CI,1.079-4.599])were independent risk factors for postoperative infection in patients with gastric cancer.Conclusion Incidence of post-operative infection in patients with gastric cancer in this hospital is high,health care workers can take effective preventive and control measures against the related risk factors,especially control of underlying diseases of peptic ulcer before operation and pre-operative hospital stay.
引文
[1]Krejs GJ.Gastric cancer:Epidemiology and risk factors[J].Dig Dis,2010,28(4-5):600-603.
[2]He C,Li C,Zhang Y,et al.Influence of antimicrobial agents in postoperative infection for patients with gastric cancer[J].Biomed Res,2017,28(15):6777-6780.
[3]肖宁,韩毅,吴欣.胃癌患者术后感染的相关因素分析[J].中华医院感染学杂志,2014,24(8):1995-1997.
[4]Wang Z,Liu L,Jiang X,et al.Pathogen infection and drug resistance in laparoscopy-assisted total gastrectomy for upper gastric cancer[J].Pak J Pharm Sci,2017,30(3):1143-1149.
[5]郭春龙,朱晓敏,高羽.胃癌术后继发肺部感染的临床分析与对策[J].中国医学工程,2013,21(11):71.
[6]魏慧娴,吴永泉,吴定昌.胃癌手术患者医院感染临床特征分析[J].中华医院感染学杂志,2014,24(14):3552-3556.
[7]江彦,胡晓慧,彭睿,等.胃癌患者术后医院感染病原菌与影响因素分析[J].中华医院感染学杂志,2016,26(5):1005-1007.
[8]史振贵.消化性溃疡与胃癌的关系分析.[J].吉林医学,2011,32(3):542.
[9]Han JH,Jeong O,Ryu SY,et al.Efficacy of single-dose antimicrobial prophylaxis for preventing surgical site infection in radical gastrectomy for gastric carcinoma[J].J Gastric Cancer,2014,14(3):156-163.
[10]Inokuchi M,Kojima K,Kato K,et al.Risk factors for postoperative pulmonary complications after gastrectomy for gastric cancer[J].Surg Infect(Larchmt),2014,15(3):314-321.
[11]Wei Z,Tan B,Cao S,et al.The influence of neoadjuvant chemotherapy on gastric cancer patients’postoperative infectious complications:what is the negative role played by the intestinal barrier dysfunction?[J].Oncotarget,2017,8(26):43376-43388.
[12]朱正纲.我国胃癌外科2017年热点回顾与未来展望[J].中华胃肠外科杂志,2018,21(1):7-14.
[13]Sun Z,Zhu Y,Xu G,et al.Regression analysis of the risk factors for postoperative nosocomial infection in patients with abdominal tumors:experience from a large cancer centre in China[J].Drug Discov Ther,2015,9(6):411-416.
[14]Jung KH,Kim SM,Choi MG,et al.Preoperative smoking cessation can reduce postoperative complications in gastric cancer surgery[J].Gastric Cancer,2014,18(5):683-690.
[15]Fletcher RH,Fairfield KM.Vitamins for chronic disease prevention in adults:clinical applications[J].JAMA,2002,287(23):3127-3129.
[16]曹军,刘洪强,何阳,等.血管介入治疗预防性应用抗菌药物对术后感染发生率影响的临床研究[J].临床和实验医学杂志,2013,12(12):924-925.
[17]斯诚,沈海鹏,张韵.老年胃癌患者术后医院感染相关因素分析[J].中华医院感染学杂志,2013,23(18):4421-4423.
[18]范西红,张小化,张小桥,等.胃癌手术预防性抗菌药物应用的调查分析[J].中华医院感染学杂志,2010,20(13):1915-1917.
[19]Shahid H,Liou GI,Crosson CE.Opioid receptor activation:suppression of ischemia/reperfusion-induced production of TNF-αin the retina[J].Invest Ophthalmol Vis Sci,2011,52(5):2577-2583.
[2]He C,Li C,Zhang Y,et al.Influence of antimicrobial agents in postoperative infection for patients with gastric cancer[J].Biomed Res,2017,28(15):6777-6780.
[3]肖宁,韩毅,吴欣.胃癌患者术后感染的相关因素分析[J].中华医院感染学杂志,2014,24(8):1995-1997.
[4]Wang Z,Liu L,Jiang X,et al.Pathogen infection and drug resistance in laparoscopy-assisted total gastrectomy for upper gastric cancer[J].Pak J Pharm Sci,2017,30(3):1143-1149.
[5]郭春龙,朱晓敏,高羽.胃癌术后继发肺部感染的临床分析与对策[J].中国医学工程,2013,21(11):71.
[6]魏慧娴,吴永泉,吴定昌.胃癌手术患者医院感染临床特征分析[J].中华医院感染学杂志,2014,24(14):3552-3556.
[7]江彦,胡晓慧,彭睿,等.胃癌患者术后医院感染病原菌与影响因素分析[J].中华医院感染学杂志,2016,26(5):1005-1007.
[8]史振贵.消化性溃疡与胃癌的关系分析.[J].吉林医学,2011,32(3):542.
[9]Han JH,Jeong O,Ryu SY,et al.Efficacy of single-dose antimicrobial prophylaxis for preventing surgical site infection in radical gastrectomy for gastric carcinoma[J].J Gastric Cancer,2014,14(3):156-163.
[10]Inokuchi M,Kojima K,Kato K,et al.Risk factors for postoperative pulmonary complications after gastrectomy for gastric cancer[J].Surg Infect(Larchmt),2014,15(3):314-321.
[11]Wei Z,Tan B,Cao S,et al.The influence of neoadjuvant chemotherapy on gastric cancer patients’postoperative infectious complications:what is the negative role played by the intestinal barrier dysfunction?[J].Oncotarget,2017,8(26):43376-43388.
[12]朱正纲.我国胃癌外科2017年热点回顾与未来展望[J].中华胃肠外科杂志,2018,21(1):7-14.
[13]Sun Z,Zhu Y,Xu G,et al.Regression analysis of the risk factors for postoperative nosocomial infection in patients with abdominal tumors:experience from a large cancer centre in China[J].Drug Discov Ther,2015,9(6):411-416.
[14]Jung KH,Kim SM,Choi MG,et al.Preoperative smoking cessation can reduce postoperative complications in gastric cancer surgery[J].Gastric Cancer,2014,18(5):683-690.
[15]Fletcher RH,Fairfield KM.Vitamins for chronic disease prevention in adults:clinical applications[J].JAMA,2002,287(23):3127-3129.
[16]曹军,刘洪强,何阳,等.血管介入治疗预防性应用抗菌药物对术后感染发生率影响的临床研究[J].临床和实验医学杂志,2013,12(12):924-925.
[17]斯诚,沈海鹏,张韵.老年胃癌患者术后医院感染相关因素分析[J].中华医院感染学杂志,2013,23(18):4421-4423.
[18]范西红,张小化,张小桥,等.胃癌手术预防性抗菌药物应用的调查分析[J].中华医院感染学杂志,2010,20(13):1915-1917.
[19]Shahid H,Liou GI,Crosson CE.Opioid receptor activation:suppression of ischemia/reperfusion-induced production of TNF-αin the retina[J].Invest Ophthalmol Vis Sci,2011,52(5):2577-2583.
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |