Risk Factor Analysis and Prevention of Pneumonia of Patients after Esophagectomy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHOUXiao-wei ,  WANZhi-yu , YINJun-tai , LIXiao-ming , LUYong-guo , MOUHai-de , MEIBo

Department of Thoracic and Cardiovascular Surgery, Guangyuan Central Hospital, Guangyuan 628000, Sichuan, P. R. China;

Corresponding?author：

WANZhi-yu, Email: kelangyanyan@163.com

Keywords：

Esophageal carcinoma; Perioperative period; Pneumonia; Risk factor

DOI：

10.7507/1007-4848.20140186

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To explore risk factors of pneumonia of patients after esophagectomy and its preventive measures. Methods Clinical data of 258 patients undergoing esophagectomy in Guangyuan Central Hospital between 2009 and 2012 were retrospectively analyzed. According to whether they had pneumonia after esophagectomy, all the 258 patients were divided into 2 groups. In the pneumonia group, there were 86 patients including 62 males and 24 females with their age of 65.1 (45-84)years, who all had pneumonia after esophagectomy. In the control group, there were 172 patients including 124 males and 48 females with their age of 60.2 (43-78)years, who didn't have pneumonia after esophagectomy. Preoperative pulmonary function, age, smoking history, anastomotic location, intraoperative blood loss, pneumonia and other perioperative complications were compared between the 2 groups. Multivariate logistic regression was performed to analyze risk factors of pneumonia after esophagectomy. Results Univariate analysis showed that incidences of moderate or severe pulmonary dysfunction, smoking history (≥400 cigarettes per year), old age (≥65 years), laryngeal recurrent nerve injury, perioperative blood loss (≥1 000 ml), operation time longer than 4 hours, and preoperative diabetes mellitus of the pneumonia group were significantly higher than those of the control group (P < 0.05). Multivariate logistic regression analysis showed that moderate or severe pulmonary dysfunction (P=0.022), smoking history (≥400 cigarettes per year, P=0.000), old age (≥65 years, P=0.026), laryngeal recurrent nerve injury (P=0.002), and perioperative blood loss (≥1000 ml, P=0.020)were main risk factors of pneumonia after esophagectomy. Conclusions Moderate or severe pulmonary dysfunction, smoking history (≥400 cigarettes per year), old age (≥65 years), laryngeal recurrent nerve injury and perioperative blood loss (≥1 000 ml)are main risk factors of pneumonia after esophagectomy. Preoperative smoking cessation, pulmonary function exercise, airway preparation, careful hemostasis, and avoidance of laryngeal recurrent nerve injury are helpful to prevent pneumonia after esophagectomy.

Citation： ZHOUXiao-wei, WANZhi-yu, YINJun-tai, LIXiao-ming, LUYong-guo, MOUHai-de, MEIBo. Risk Factor Analysis and Prevention of Pneumonia of Patients after Esophagectomy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(5): 649-653. doi: 10.7507/1007-4848.20140186 Copy

1.	中國醫師協會食管外科專家委員會, 方文濤, 張遜.微創食管癌切除術專家共識.中華胸心血管外科雜志, 2013, 29(7):385-387.
2.	王文憑, 陳龍奇.食管癌外科治療新進展.中華臨床醫師雜志:電子版, 2009, 3(11):1797-1804.
3.	Atkins BZ, Shah AS, Hutcheson KA, et al. Reducing hospital morbidity and mortality following esophagectomy. Ann Thorac Surg, 2004, 78(4):1170-1176.
4.	馬良赟, 廖澤飛, 王耿杰.食管癌術后肺部并發癥危險因素的多因素Logistic回歸分析.中國危重病急救醫學, 2011, 23(10):625-628.
5.	穆魁津, 林友華, 主編.肺功能測定原理與臨床應用.北京:北京醫科大學中國協和醫科大學聯合出版社, 1992.322-329.
6.	中華結核與呼吸雜志編委會.醫院內獲得性支氣管-肺感染診斷標準.中華結核與呼吸雜志, 1990, 13(6):372.
7.	Law S, Wong KH, Kwok KF, et a1. Predictive factors for post-operative pulmonary complications and mortality after esophagectomy for cancer. Ann Surg, 2004, 240(5):791-800.
8.	Ferguson MK, Durkin AE. Preoperative prediction of the risk of pulmonary complications after esophagectomy for cancer. J Thorac Cardiovasc Surg, 2002, 123(4):661-669.
9.	王麗君, 顧連兵, 蔣大明, 等.食管癌術后肺部感染圍手術期影響因素分析.中華醫學雜志, 2012, 92(19):1310-1312.
10.	石平, 熊小敏, 曾茄, 等.食管癌術后肺部感染危險因素的評估.四川醫學, 2010, 31(8):1117-1118.
11.	王莉, 張爽, 白茹, 等.食管癌住院患者術前營養風險篩查與分析.蚌埠醫學院學報, 2012, 37(10):1181-1182.
12.	韓東景, 趙楠, 李偉, 等.食管癌患者術前營養不足和營養風險發生率及臨床營養支持現狀調查.中華腫瘤防治雜志, 2013, 20(16):1274-1277.
13.	朱建國, 凌寶存, 胡波.胸部手術后肺炎臨床分析.臨床軍醫雜志, 2004, 32(5):47-49.
14.	張淵, 祝蟮珠.術后肺炎的研究進展.中華醫院感染學雜志, 2007, 17(10):1318-1320.
15.	楊瑞森, 陳久成, 秦篤祥, 等.食管癌切除、食管床全胃移植頸部吻合術:附335例分析.山東醫藥, 1996, 36(12):16-17.
16.	趙雍凡, 王資斌, 伍佇, 等.不同平面胃食管吻合術后食管腔內24小時pH值監測.中國胸心血管外科臨床雜志, 1998, 5(3):144-145.
17.	陳克能, 徐光煒, 師曉天, 等.輸血對食管癌病人免疫功能的影響.中華胸心血管外科雜志, 2002, 17(2):79-81.
18.	漆奮強.影響食管癌圍手術期體液免疫變化的因素.中國癌癥防治雜志, 2010, 2(3):236-238.
19.	林巧燕, 李潔羽, 林萬松, 等.圍手術期成分輸血對食管癌患者CD4+CD25+CD127dim/-Treg細胞的影響.福建醫藥雜志, 2012, 34(5):49-52.
20.	潘開云, 張文山, 黃榮智, 等.食管癌切除術管狀胃與全胃重建食管的對比研究.中國腫瘤外科雜志, 2012, 4(4):236-237.
21.	孫超, 石維平, 束余生, 等.管狀胃在食管癌切除術頸部吻合中的應用.中國胸心血管外科臨床雜志, 2012, 19(2):148-150.
22.	李勇, 王化勇, 王雷, 等.管狀胃與全胃代食管術治療食管癌的療效比較.臨床腫瘤學雜志, 2013, 18(8):144-145.
23.	茹玉航.管狀胃對食管癌切除術后患者生活質量的影響.實用癌癥雜志, 2013, 28(4):376-378.
24.	劉樹, 汪道峰, 方翼, 等.食管癌三野淋巴結清掃術后肺部感染的危險因素分析.中華醫院感染學雜志, 2013, 23(11):2604-2606.
25.	蔡英杰, 何澤鋒, 柯孫葵, 等.胸段食管癌鎖骨上淋巴結清掃的臨床價值.中國胸心血管外科臨床雜志, 2013, 20(1):63-66.

1. 中國醫師協會食管外科專家委員會, 方文濤, 張遜.微創食管癌切除術專家共識.中華胸心血管外科雜志, 2013, 29(7):385-387.
2. 王文憑, 陳龍奇.食管癌外科治療新進展.中華臨床醫師雜志:電子版, 2009, 3(11):1797-1804.
3. Atkins BZ, Shah AS, Hutcheson KA, et al. Reducing hospital morbidity and mortality following esophagectomy. Ann Thorac Surg, 2004, 78(4):1170-1176.
4. 馬良赟, 廖澤飛, 王耿杰.食管癌術后肺部并發癥危險因素的多因素Logistic回歸分析.中國危重病急救醫學, 2011, 23(10):625-628.
5. 穆魁津, 林友華, 主編.肺功能測定原理與臨床應用.北京:北京醫科大學中國協和醫科大學聯合出版社, 1992.322-329.
6. 中華結核與呼吸雜志編委會.醫院內獲得性支氣管-肺感染診斷標準.中華結核與呼吸雜志, 1990, 13(6):372.
7. Law S, Wong KH, Kwok KF, et a1. Predictive factors for post-operative pulmonary complications and mortality after esophagectomy for cancer. Ann Surg, 2004, 240(5):791-800.
8. Ferguson MK, Durkin AE. Preoperative prediction of the risk of pulmonary complications after esophagectomy for cancer. J Thorac Cardiovasc Surg, 2002, 123(4):661-669.
9. 王麗君, 顧連兵, 蔣大明, 等.食管癌術后肺部感染圍手術期影響因素分析.中華醫學雜志, 2012, 92(19):1310-1312.
10. 石平, 熊小敏, 曾茄, 等.食管癌術后肺部感染危險因素的評估.四川醫學, 2010, 31(8):1117-1118.
11. 王莉, 張爽, 白茹, 等.食管癌住院患者術前營養風險篩查與分析.蚌埠醫學院學報, 2012, 37(10):1181-1182.
12. 韓東景, 趙楠, 李偉, 等.食管癌患者術前營養不足和營養風險發生率及臨床營養支持現狀調查.中華腫瘤防治雜志, 2013, 20(16):1274-1277.
13. 朱建國, 凌寶存, 胡波.胸部手術后肺炎臨床分析.臨床軍醫雜志, 2004, 32(5):47-49.
14. 張淵, 祝蟮珠.術后肺炎的研究進展.中華醫院感染學雜志, 2007, 17(10):1318-1320.
15. 楊瑞森, 陳久成, 秦篤祥, 等.食管癌切除、食管床全胃移植頸部吻合術:附335例分析.山東醫藥, 1996, 36(12):16-17.
16. 趙雍凡, 王資斌, 伍佇, 等.不同平面胃食管吻合術后食管腔內24小時pH值監測.中國胸心血管外科臨床雜志, 1998, 5(3):144-145.
17. 陳克能, 徐光煒, 師曉天, 等.輸血對食管癌病人免疫功能的影響.中華胸心血管外科雜志, 2002, 17(2):79-81.
18. 漆奮強.影響食管癌圍手術期體液免疫變化的因素.中國癌癥防治雜志, 2010, 2(3):236-238.
19. 林巧燕, 李潔羽, 林萬松, 等.圍手術期成分輸血對食管癌患者CD4+CD25+CD127dim/-Treg細胞的影響.福建醫藥雜志, 2012, 34(5):49-52.
20. 潘開云, 張文山, 黃榮智, 等.食管癌切除術管狀胃與全胃重建食管的對比研究.中國腫瘤外科雜志, 2012, 4(4):236-237.
21. 孫超, 石維平, 束余生, 等.管狀胃在食管癌切除術頸部吻合中的應用.中國胸心血管外科臨床雜志, 2012, 19(2):148-150.
22. 李勇, 王化勇, 王雷, 等.管狀胃與全胃代食管術治療食管癌的療效比較.臨床腫瘤學雜志, 2013, 18(8):144-145.
23. 茹玉航.管狀胃對食管癌切除術后患者生活質量的影響.實用癌癥雜志, 2013, 28(4):376-378.
24. 劉樹, 汪道峰, 方翼, 等.食管癌三野淋巴結清掃術后肺部感染的危險因素分析.中華醫院感染學雜志, 2013, 23(11):2604-2606.
25. 蔡英杰, 何澤鋒, 柯孫葵, 等.胸段食管癌鎖骨上淋巴結清掃的臨床價值.中國胸心血管外科臨床雜志, 2013, 20(1):63-66.

Previous Article
胸部鈍挫傷所致三尖瓣重度反流一例
Next Article
Correlative Research of Ki-67 Antigen in Breast Cancer

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Risk Factor Analysis and Prevention of Pneumonia of Patients after Esophagectomy

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content