Postoperative pneumonia after major lung resection
Postoperative pneumonia after major lung resection
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DOI：
10.1164/rccm.200510-1556oc
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发表时间：
2006-05-15
影响因子：
24.7
通讯作者：
Regnard, Jean-Francois
中科院分区：
文献类型：
--
作者：
Schussler, Olivier;Alifano, Marco;Regnard, Jean-Francois
背景：术后肺炎（POP）是肺切除术后危及生命的并发症。发病率，致病菌，诱发因素，和结果是知之甚少。设计：前瞻性观察study.Methods：一项前瞻性研究，所有患者进行重大肺切除术的非感染性疾病进行了6个月的时间。系统地进行了术中支气管抽吸物的培养。所有疑似肺炎的患者在抗生素治疗前进行支气管镜采样和培养。通过分析术中样本，在136例患者中的31例（22.8%）中确定了支气管定植。POP的发生率为25%（42/168）。分别在24例和18例病例中记录了微生物学记录和未记录的肺炎。最常鉴定的病原体是嗜血杆菌属、链球菌属以及假单胞菌属和沙雷氏菌属（程度小得多）。在定植和非定植患者中，POP分别发生在31例和105例中的15例和20例（p = 0.0010;相对风险，2.54）。发生POP的42例患者中有8例死亡，未发生POP的126例患者中有3例死亡（p = 0.0012）。POP患者需要无创通气或重新插管的频率高于未发生POP的患者（分别为p < 0.0000001和p = 0.00075）。POP与更长的重症监护室和住院时间相关（分别为p < 0.0000001和p = 0.0000005）。多因素分析表明，慢性阻塞性肺疾病，切除范围，存在术中支气管定植，男性是独立的危险因素POP.Conclusions：肺炎获得性院内肺切除术是一个相对频繁的并发症，与术后发病率和死亡率的重要比例。
Background: Postoperative pneumonia (POP) is a life-threatening complication of lung resection. The incidence, causative bacteria, predisposing factors, and outcome are poorly understood.Design: Prospective observational study.Methods: A prospective study of all patients undergoing major lung resections for noninfectious disease was performed over a 6-mo period. Culture of intraoperative bronchial aspirates was systematically performed. All patients with suspicion of pneumonia underwent bronchoscopic sampling and culture before antibiotherapy.Results: One hundred and sixty-eight patients were included in the study. Bronchial colonization was identified in 31 of 136 patients (22.8%) on analysis of intraoperative samples. The incidence of POP was 25% (42 of 168). Microbiologically documented and nondocumented pneumonias were recorded in 24 and 18 cases, respectively. Hoemophilus species, Streptococcus species, and, to a much lesser extent, Pseudomonas and Serratia species were the most frequently identified pathogens. Among colonized and noncolonized patients, POP occurred in 15 of 31 and 20 of 105 cases, respectively (p = 0.0010; relative risk, 2.54). Death occurred in 8 of 42 patients who developed POP and in 3 of 126 of patients who did not (p = 0.0012). Patients with POP required noninvasive ventilation or reintubation more frequently than patients who did not develop POP (p < 0.0000001 and p = 0.00075, respectively). POP was associated with longer intensive care unit and hospital stay (p < 0.0000001 and p = 0.0000005, respectively). Multivariate analysis showed that chronic obstructive pulmonary disease, extent of resection, presence of intraoperative bronchial colonization, and male sex were independent risk factors for POP.Conclusions: Pneumonia acquired in-hospital represents a relatively frequent complication of lung resections, associated with an important percentage of postoperative morbidity and mortality.