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中华肺部疾病杂志(电子版)

中华肺部疾病杂志(电子版) ›› 2022, Vol. 15 ›› Issue (05) : 653 -656. doi: 10.3877/cma.j.issn.1674-6902.2022.05.008

论著

慢性鼻窦炎FESS术后并发肺部感染危险因素分析
张焱1, 杨莉莉1, 杨景森1, 季迪1, 宋彩萍1,†()   
  1. 1. 400037　重庆，陆军（第三）军医大学第二附属医院耳鼻咽喉科
  • 收稿日期:2022-04-01 出版日期:2022-10-25
  • 通信作者: 宋彩萍
  • 基金资助:
    重庆市技术创新与应用发展专项面上项目(cstc2019jscx-msxm0466)

Analysis of risk factors of pulmonary infection in patients with chronic rhinosinusitis after functional endoscopic sinus surgery

Yan Zhang1, Lili Yang1, Jingsen Yang1, Di Ji1, Caiping Song1,†()   

  1. 1. Department of Otolaryngology, the Second Affiliated Hospital of Army Medical University, Chongqing 400037, China
  • Received:2022-04-01 Published:2022-10-25
  • Corresponding author: Caiping Song
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引用本文：

张焱, 杨莉莉, 杨景森, 季迪, 宋彩萍. 慢性鼻窦炎FESS术后并发肺部感染危险因素分析[J]. 中华肺部疾病杂志(电子版), 2022, 15(05): 653-656.

Yan Zhang, Lili Yang, Jingsen Yang, Di Ji, Caiping Song. Analysis of risk factors of pulmonary infection in patients with chronic rhinosinusitis after functional endoscopic sinus surgery[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2022, 15(05): 653-656.

目的

分析慢性鼻窦炎(CRS)功能性鼻内镜手术(FESS)术后并发肺部感染的危险因素及其病原菌分布特点。

方法

选取2019年1月至2021年12月我院收治的CRS行FESS手术1 037例为对象，采用全自动微生物分析患者痰液标本，Logistic回归分析CRS行FESS手术患者并发肺部感染危险因素。

结果

1 037例CRS行FESS术后肺部感染78例(7.52%)。主要表现为发热、咳嗽、咳痰，影像学示双肺炎症56例(71.79%)，左肺炎症14例(17.95%) ，右肺炎症8例(10.26%)，右侧胸腔积液16例(22.22%)，左侧胸腔积液20例(27.78%) ，双侧胸腔积液36例(50%) 。痰病原菌培养78例共分离出8种141株病原菌，其中G－ 86株(60.99%)包括肺炎克雷伯菌42株(29.79%)、铜绿假单胞菌26株(18.44%)、鲍氏不动杆菌18株(12.77%)；G+ 45株(31.91%)包括金黄色葡萄球菌19株(13.48%)、表皮葡萄球菌16株(11.35%)、肺炎链球菌10株(7.09%)；真菌10株(7.09%)。Logistic回归分析显示高龄、合并糖尿病、手术时间、呼吸道侵入性操作是发生术后感染的危险因素(P<0.05)。

结论

CRS行FESS手术肺部感染病原菌以肺炎克雷伯菌、铜绿假单细胞菌、金黄色葡萄球菌为主，高龄、合并基础疾病、手术时长、呼吸道侵入性操作是影响CRS行FESS手术肺部感染的危险因素，加强围术期高危因素管理，可降低肺部感染发生率。

关键词: 肺部感染, 慢性鼻窦炎, 功能性鼻内镜手术, 临床特征, 影响因素
Objective

To analyze the risk factors and pathogen distribution characteristics of pulmonary infection in patients with chronic rhinosinusitis (CRS) after functional endoscopic sinus surgery (FESS).

Methods

A total of 1 037 patients with CRS undergoing FESS in our hospital from January 2019 to December 2021 were selected as subjects. The sputum samples were detected by the automatic microorganism analyzer. The pathogens and risk factors of pulmonary infection in patients undergoing FESS for CRS were analyzed using multivariate Logistic regression.

Results

Among 1 037 patients with CRS undergoing FESS, 78 patients (7.52%) had pulmonary infection. The main clinical manifestations of the infected patients were cough, expectoration and fever. Imaging examination showed that there were 56 cases of bilateral pneumonia (71.79%), 14 cases of left pneumonia (17.95%), 8 cases of right pneumonia (10.26%), 16 cases of right pleural effusion (22.22%), 20 cases of left pleural effusion (27.78%), and 36 cases (50%) of bilateral pleural effusion. The results of pathogen culture showed that 141 strains of 8 pathogens were isolated from 78 patients, including 86 strains (60.99%)of Gram-negative bacteria, 42 strains (29.79%) of Klebsiella pneumoniae, 26 strains (18.44%) of Pseudomonas aeruginosa, 18 strains (12.77%) of Acinetobacter baumannii; 45 strains (31.91%) of Gram-positive bacteria, 19 strains(13.48%) of gold Staphylococcus aureus, 16 strains (11.35%) of Staphylococcus epidermidis, 10 strains(7.09%) of Streptococcus pneumoniae and 10 strains (7.09%) of fungi. The Logistic regression analysis showed that advanced age, diabetes, long operation time and invasive operation on respiratory tract were risk factors for postoperative nosocomial infection (P<0.05).

Conclusion

The main pathogens of pulmonary infection in patients with CRS after FESS are Klebsiella pneumoniae, Pseudomonas aeruginosa and Staphylococcus aureus. Advanced age, comorbidity, long operation time, invasive operation on respiratory tract are main factors affecting pulmonary infection in patients with CRS after FESS. The perioperative management of high-risk patients should be strengthened to reduce the risk of pulmonary infection.

Key words: Pulmonary infection, Chronic rhinosinusitis, Functional endoscopic sinus surgery, Clinical characteristics, Influencing factors
表1 病原菌分布及构成比
病原菌 例数(n＝141) 构成比(%)
G－ 86 60.99
  肺炎克雷伯菌 42 29.79
  铜绿假单胞菌 26 18.44
  鲍氏不动杆菌 18 12.77
G+ 45 31.91
  金黄色葡萄球菌 19 13.48
  肺炎链球菌 10 7.09
  表皮葡萄球菌 16 11.35
真菌 10 7.09
  白色念珠菌 6 4.26
  白色假丝酵母菌 4 2.83
表2 CRS患者术后肺部感染及单因素分析
临床资料   例数 感染例数 感染率(%) χ2值 P值
性别 男/女 669/368 47/31 7.03/8.42 0.668 0.414
年龄(岁) ≥60 95 942 14.74    
  <60 14 64 6.79 7.827 0.005
合并糖尿病 有 112 15 13.39 6.222 0.013
  无 925 63 6.81    
吸烟史 有 661 59 8.93 5.167 0.023
  无 376 19 5.05    
住院时长(d) ≥7 45 8 17.78 7.1 14 0.016a
  <7 992 70 7.06    
手术时长(h) ≥2 387 40 10.34 7.030 0.008
  <2 650 38 5.85    
呼吸道侵入性操作 有 612 60 9.80 11.182 0.001
  无 425 18 4.24    
出血量(ml) ≥200 8 2 25.00 3.541 0.116a
  <200 1 029 76 7.39    
表3 CRS患者术后肺部感染多因素Logistic回归分析
临床资料 β S.E. Wald值 P值 OR值 95%CI
年龄 1.265 0.436 8.424 0.004 3.544 1.508~8.328
合并糖尿病 0.626 0.312 4.025 0.045 1.870 1.014~3.447
手术时间 0.847 0.396 4.582 0.032 2.333 1.074~5.068
呼吸道侵入性操作 1.042 0.327 10.159 0.001 2.835 1.494~5.381
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