本文關鍵詞： 食管癌術后 肺部感染 危險因素　出處：《新鄉(xiāng)醫(yī)學院》2015年碩士論文　論文類型：學位論文

【摘要】：背景食管癌是我國最常見的惡性腫瘤之一,其臨床治療效果相當有限,5年生存率低于15%,而早期診斷則是提高食管癌生存率的最佳方法；對于已經(jīng)明確診斷的食管癌患者,手術治療則是其中最有效的治療方法。但由于患者自身體質因素以及合并病癥等影響,食管癌術后容易出現(xiàn)一系列并發(fā)癥,其中肺部感染發(fā)生率較高,影響患者術后恢復,增加術后死亡率。目的通過分析食管癌術后肺部感染產(chǎn)生的危險因素,探索預防與治療術后肺部感染的有效途徑,降低食管癌術后肺部感染的發(fā)生率。方法收集新鄉(xiāng)醫(yī)學院第一附屬醫(yī)院胸外科本組2012年3月到2013年12月間無合并其它感染的食管癌(均為鱗癌)病例187例,均在本院行食管癌根治術治療。采集病患相關臨床資料,獲取年齡、合并既往病史(慢性阻塞性肺疾病、高血壓病、糖尿病、冠心病)、吸煙史、手術方式、術中通氣方式、手術時間及腫瘤分期等基本資料；對患者進行術后臨床觀察,根據(jù)是否發(fā)生肺部感染,將187例患者分為兩組,一組為術后發(fā)生肺部感染的患者,另一組為術后無肺部感染發(fā)生的患者。應用描述性統(tǒng)計分析方法描述患者基本資料；采用卡方檢驗進行計數(shù)資料兩變量分析或t檢驗進行計量資料兩變量分析,比較兩組病患基本資料；采用logistic回歸分析法篩選影響食管癌術后肺部感染產(chǎn)生的相關危險因素。結果通過統(tǒng)計分析對比,肺部感染組與非肺部感染組患者年齡、合并慢性阻塞性肺疾病、合并糖尿病、吸煙史、手術時間及腫瘤分期具有統(tǒng)計學意義(P0.05)。而術中通氣方式、手術方式、合并高血壓病以及合并冠心病病史并沒有產(chǎn)生顯著性差異(P0.05)。結論本研究發(fā)現(xiàn),病患年齡大、合并COPD、合并糖尿病、長期吸煙史、手術時間超過3小時及腫瘤分期處于Ⅲ期±Ⅳ期均是發(fā)生術后肺部感染的危險因素。
[Abstract]:Background esophageal cancer is one of the most common malignant tumors in China. Its clinical therapeutic effect is very limited, the 5-year survival rate is less than 15%, and early diagnosis is the best way to improve the survival rate of esophageal cancer. Surgical treatment is one of the most effective treatment methods. However, due to the influence of the patient's own physical condition and complicated diseases, a series of complications are likely to occur after the operation of esophageal cancer, in which the incidence of pulmonary infection is high, which affects the patient's postoperative recovery. Objective to explore the effective ways to prevent and treat postoperative pulmonary infection by analyzing the risk factors of postoperative pulmonary infection of esophageal carcinoma. Methods A total of 187 cases of esophageal cancer (all squamous cell carcinomas) with no other infection between March 2012 and December 2013 were collected from chest surgery department, the first affiliated hospital of Xinxiang Medical College, to reduce the incidence of postoperative pulmonary infection. All patients were treated with radical resection of esophageal cancer in our hospital. Clinical data were collected, age was obtained, and previous history (chronic obstructive pulmonary disease, hypertension, diabetes, coronary heart disease, smoking history, operative method, intraoperative ventilation) was obtained. After surgery, 187 patients were divided into two groups according to whether or not they had pulmonary infection. The first group was patients with postoperative pulmonary infection. The other group was the patients who had no pulmonary infection after operation. The basic data of the patients were described by descriptive statistical analysis, and the counting data were analyzed by chi-square test, or the data were analyzed by t-test. The basic data of the two groups were compared, and the risk factors of pulmonary infection after esophageal cancer operation were screened by logistic regression analysis. Results by statistical analysis, the age of patients with pulmonary infection was compared with that of non-pulmonary infection. Chronic obstructive pulmonary disease (COPD), diabetes mellitus, smoking history, operation time and tumor staging were statistically significant (P 0.05). There was no significant difference in the history of hypertension and coronary heart disease (P 0.05). Conclusion this study found that patients with older age, complicated with COPDs, complicated with diabetes, and had a long history of smoking. Postoperative pulmonary infection was associated with postoperative pulmonary infection after operation for more than 3 hours and stage 鈪，

本文編號：1546534