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| 食管癌患者术后肺部感染的围术期影响因素分析 |
| Influence of perioperative factors on postoperative pulmonary infection in patients with esophageal cancer |
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| DOI： |
| 中文关键词: 麻醉因素 肺部感染 食管癌 单肺通气 |
| 英文关键词: Anesthesia factor Pulmonary infection Esophageal cancer Single lung ventilation |
| 基金项目: |
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| 中文摘要: |
| 目的 探讨围术期相关因素对食管癌患者术后肺部感染的影响。方法 回顾性分析2012年8月至2016年8月于我院行食管癌根治术患者的临床资料，150例符合入选标准，根据术后是否并发肺部感染分为肺部感染组(n=32)与非感染组(n=118)。记录两组麻醉药物使用总量，记录两组插管时间、单肺通气时间、手术时间、全麻时间、拔管时间、术中出血量、晶体补充量、胶体补充量、术中总补液量、麻醉方法和单肺通气方式，比较两组非间断膨肺比例、鼻导管吸痰比例和术后哌替啶镇痛比例。通过Logistic回归分析预测肺部感染发生的危险因素。结果 肺部感染组舒芬太尼与丙泊酚用量明显多于，单肺通气时间、手术时间、全麻时间、拔管时间明显长于，非间断膨肺比例、鼻导管吸痰比例和术后哌替啶镇痛比例明显高于非感染组(P<0.05)；两组咪达唑仑与顺阿曲库铵用量、插管时间、术中出血量、晶体补充量、胶体补充量、术中总补液量、麻醉方法及单肺通气方式差异均无统计学意义。Logistic回归分析显示，舒芬太尼用量每增加7.5 μg(OR=1.65，95%CI 1.24～2.85)、单肺通气时间每增加10 min(OR=2.14，95%CI 1.32～3.62)、全麻时间每增加20 min(OR=1.87，95%CI 1.46～3.15)、鼻导管吸痰(OR=2.03，95%CI 1.27～3.46)及术后哌替啶镇痛(OR=3.44，95%CI 2.25～5.13)是预测术后肺部感染发生的危险因素。结论 麻醉中使用合适的舒芬太尼总量、减少单肺通气时间与全麻时间、应用纤维支气管镜吸痰及术后采取自控静脉镇痛，有利于减少食管癌患者术后肺部感染的发生。 |
| 英文摘要: |
| Objective To explore the influence of perioperative factors on postoperative pulmonary infection in patients with esophageal cancer. Methods According to the inclusion criteria in the present study, clinical data of 150 patients undergoing radical prostatectomy for esophageal cancer in our hospital was retrospectively analyzed. In accordance with whether the occurrence of pulmonary infection or not, 32 patients were regarded as pulmonary infection group and 118 patients were designated as no-pulmonary infection group. The dosage of anesthesia drug, intubation time, single lung ventilation time, operation time, anesthesia time, extubation time, intraoperative blood loss, crystal transshipment, colloid transshipment, intraoperative total amount of rehydration, anesthesia methods and one-lung ventilation way were recorded. The indexes of anesthesia factors were compared between the two groups. Multivariable logistic regression analysis was performed to predict the risks of postoperative pulmonary infection for anesthesia factors. Results Total sufentanil and propofol dose, single lung ventilation time, operation time, anesthesia time, extubation time and the percentage of uninterrupted expansion of lung, nose sputum suction catheter and pethidine postoperative analgesia in pulmonary infection group were respectively significantly higher than that of non-pulmonary infection group (all P<0.05). There were no statistical differences of dosage of midazolam and atracurium, intubation time, intraoperative blood loss, crystalloid volume, colloid volume, the total infusion volume, anesthesia methods and intraoperative one-lung ventilation mode between the two groups. Multivariable logistic regression analysis revealed that each increase of sufentanil total dose of 7.5 μg (OR=1.65, 95%CI 1.24-2.85), each increase of 10 min in single lung ventilation time (OR=2.14, 95%CI 1.32-3.62), each increase of 20 min in anesthesia time (OR=1.87, 95%CI 1.46-3.15), nose sputum suction catheter (OR=2.03, 95%CI 1.27-3.46)as well as pethidine postoperative analgesia (OR=3.44, 95%CI 2.25-5.13) were all risk factors for postoperative pulmonary infection (P<0.05). Conclusion Appropriate amount of sufentanil usage reduces single lung ventilation time and anesthesia time as well as implementing fiber bronchoscope for sputum suction, and postoperative use of self-control vein analgesia can decrease the incidence of postoperative pulmonary infection in esophageal cancer patients. |
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