| 张帆,郑世信,彭一纯.喉癌射频消融术后气管切开病人下呼吸道感染的影响因素分析[J].安徽医药,2021,25(7):1372-1375. |
| 喉癌射频消融术后气管切开病人下呼吸道感染的影响因素分析 |
| Main factors of lower respiratory tract infection in patients with tracheotomy after radiofre? quency ablation of laryngeal cancer |
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| DOI：10.3969/j.issn.1009-6469.2021.07.025 |
| 中文关键词: 气管切开术 手术后并发症 喉肿瘤 呼吸道感染 射频消融术 预防 |
| 英文关键词: Tracheotomy Postoperative complications Laryngeal neoplasms Respiratory tract infections Radiofrequency ablation Prevention |
| 基金项目:深圳市卫生计生系统科研项目立项( 201607022) |
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| 中文摘要: |
| 目的探讨喉癌病人在射频消融术后气管切开下呼吸道感染的主要影响因素。方法选取北京大学深圳医院 2012年 6月至 2016年 6月喉癌病人行射频消融术后气管切开病人 80例。留取感染病人下呼吸道分泌物分离培养细菌，对细菌采用生物鉴定系统进行鉴定。综合分析下呼吸道感染病人的主要因素并采取有效的预防措施。结果 80例病人中发生下呼吸道感染的为 11例，无下呼吸道感染为 69例，感染率为 13.75%。11例病人下呼吸道感染的分泌物细菌分离出 23株，其中革兰阴性菌 15株占 65.21%，革兰阳性菌 6株 26.09%，真菌 2株占 8.7%；单因素分析及多因素 logistic回归分析显示，手术时间［≥3 h感染者 12.73％(7/55)，无感染者 82.27％(48/55)］、术中出血量［≥400 mL感染者 16.28％( 7/43)，无感染者 83.72％( 36/43)］、术后少量出血［<50 mL感染者 26.67％(4/15)无感染者 73.33％(11/15)］、高血糖［空腹血糖 ≥8.0 mmol/L感染者 27.27％( 9/33)无感染者 72.73％( 24/33)］、伴有肺部疾病［感染，者 20.59％( 7/34)，无感染者 79.41％( 27/34)］、抗菌药物的使用［感染者 27.59％(8/29)无感染者 72.41％( 21/29)］、呼吸机的使用［感染者 36.36％( 8/22)无感染者 63.64％( 14/22)］是引起射频消融术后气管切开下呼，吸道感染的危险因素。术后随访 3年至 2019年 6月， 80例病人，中，发生过下呼吸道感染病人肿瘤复发者为 1例，占 9.09%；未发生下呼吸道感染病人肿瘤复发 10例，占 14.49%。结论手术时间、术中出血量、术后少量出血、高血糖、伴有肺部疾病、抗菌药物的使用及呼吸机的使用是引起射频消融术后气管切开下呼吸道感染的危险因素，对相关病人应采取有效的预防措施，从而减少下呼吸道感染的发生。 |
| 英文摘要: |
| Objective To investigate the main influencing factors of lower respiratory tract infection in patients with laryngeal carcinoma following tracheotomy after radiofrequency ablation.Methods From June 2012 to June 2016, 80 patients with laryngeal cancerunderwent tracheotomy after radiofrequency ablation in Peking University Shenzhen hospital. Bacteria were isolated from the lower respiratory tract secretions of infected patients and identified by biological identification system. Tthe main factors of patients with lowerrespiratory tract infection were analyzed and effective preventive measures were taken.Results Among the 80 patients, 11 had lowerrespiratory tract infection, 69 had no lower respiratory tract infection, and the infection rate was 13.75%. A total of 23 strains of bacteria were isolated from the secretions of 11 patients with lower respiratory tract infection, including 15 strains of Gram-negative bacteria (65.21%), 6 strains of Gram-positive bacteria (26.09%) and 2 strains of fungi (8.7%). Univariate analysis and multivariate logistic regression analysis showed that the operation time [≥ 3 hours, 12.73% (7 / 55) of the patients with infection, 82.27% (48 / 55) of the patients without infection], intraoperative blood loss [≥ 400 ml, 16.28% (7 / 43) of the patients with infection, 83.72% (36 / 43) of the patients without infection], a small amount of postoperative blood loss [< 50 mL, 26.67% (4/15) of patients with infection and 73.33% (11/15) of patients without infection], hyperglycemia [fasting blood glucose ≥8.0 mmol/L, 27.27% (9/33) of patients with infection, 72.73%(24/33) of patients without infection], associated with pulmonary disease [20.59% (7/34) of the infected and 79.41% (27/34) of the infected], the use of antibiotics [27.59% (8/29) of the infected, 72.41% (21/29) without infection], the use of ventilator [36.36% (8/22)with infection and 63.64% (14/22) without infection] were the risk factors for lower respiratory tract infection after radiofrequency ablation.Conclusion Operation time, intraoperative blood loss, postoperative small amount of blood loss, hyperglycemia, accompanied bylung disease, the use of antibiotics and ventilator are the risk factors of lower respiratory tract infection after radiofrequency ablation tracheotomy. Effective preventive measures should be taken for related patients to reduce the incidence of lower respiratory tract infection. |
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