摘要
目的系统评价胃癌根治术后患者发生肺部感染的危险因素。方法检索PubMed、Web of Science、Embase、中国知网、万方数据库、维普数据库和中国生物医学文献数据库,检索时间为建库至2021年12月17日。由2名研究者独立筛选文献、提取资料,采用NOS量表进行质量评价,应用RevMan 5.4、Stata15.1软件进行Meta分析。结果共纳入23项研究,总样本量为10696例。Meta分析结果显示,胃癌根治术后并发肺部感染的危险因素包括高龄[OR=2.67,95%CI(1.90,3.74),P<0.001)]、吸烟史[OR=3.09,95%CI(2.44,3.92),P<0.001]、糖尿病[OR=4.48,95%CI(1.91,10.53),P<0.001]、围手术期输血[OR=4.49,95%CI(2.65,7.61),P<0.001]、手术时间长[OR=2.19,95%CI(1.19,4.03),P=0.01]、术中出血[OR=2.46,95%CI(1.62,3.74),P<0.001]、留置胃管时间长[OR=4.03,95%CI(3.74,4.33),P<0.001]、营养风险[OR=1.82,95%CI(1.43,2.33),P<0.001]、肺部疾病史[OR=3.09,95%CI(1.89,5.05),P<0.001]、手术方式[OR=3.33,95%CI(2.93,3.79),P<0.001]、白蛋白≤30 g/L[OR=1.82,95%CI(1.39,2.37),P<0.001]、TNM分期[OR=2.18,95%CI(1.75,2.72),P<0.001]、引流管放置时间长[OR=1.48,95%CI(1.22,1.79),P<0.001]、合并基础疾病[OR=2.48,95%CI(1.83,3.35),P<0.001]、高血压史[OR=2.59,95%CI(1.48,4.52),P<0.001]、低蛋白血症[OR=3.02,95%CI(2.87,3.18),P<0.001]、伤口疼痛[OR=3.42,95%CI(1.96,5.99),P<0.001]、肺功能不全[OR=2.74,95%CI(1.84,4.09),P<0.001];胃癌根治术后并发肺部感染的保护因素为血红蛋白≥110 mg/L[OR=0.67,95%CI(0.56,0.79),P<0.001]和第1秒用力呼气容积>2 L[OR=0.22,95%CI(0.12,0.40),P<0.001]。结论高龄、吸烟史、围手术期输血、糖尿病、高血压、肺部疾病史、手术时间长、术中出血、留置胃管时间长和营养风险等是胃癌根治术后并发肺部感染的危险因素,但受纳入研究质量和数量限制,未来还需开展更多高质量的研究予以验证。
Objective To systematically evaluate the risk factors of pulmonary infection after radical gastrectomy for gastric cancer.Method PubMed,Web of Science,Embase,CNKI,Wanfang Database,VIP database and China Biomedical Literature Database were searched from the establishment of each database to December 17,2021.Two researchers independently screened literatures and extracted data.NOS scale was used for quality evaluation,and RevMan 5.4,Stata 15.1 softwares were used for Meta-analysis.Result A total of 23 studies with a total sample size of 10,696 were included.Meta-analysis results showed that risk factors for pulmonary infection after radical gastrectomy for gastric cancer included advanced age(OR=2.67,95%CI:1.90-3.74,P<0.001),smoking history(OR=3.09,95%CI:2.44-3.92,P<0.001),diabetes mellitus(OR=4.48,95%CI:1.91-10.53,P<0.001),perioperative blood transfusion(OR=4.49,95%CI:2.65-7.61,P<0.001),long operative time(OR=2.19,95%CI:1.19-4.03,P<0.001),intraoperative bleeding(OR=2.46,95%CI:1.62-3.74,P<0.001),long indwelling gastric tube time(OR=4.03,95%CI:3.74-4.33,P<0.001),nutritional risk(OR=1.82,95%CI:1.43-2.33,P<0.001),history of lung disease(OR=3.09,95%CI:1.89-5.05,P<0.001),surgical method(OR=3.33,95%CI:2.93-3.79,P<0.001),albumin≤30g/L(OR=1.82,95%CI:1.39-2.37,P<0.001),TNM staging(OR=2.18,95%CI:1.75-2.72,P<0.001),long drainage tube placement time(OR=1.48,95%CI:1.22-1.79,P<0.001),combined with underlying diseases(OR=2.48,95%CI:1.83-3.35,P<0.001),hypertension(OR=2.59,95%CI:1.48-4.52,P<0.001),hypoproteinemia(OR=3.02,95%CI:2.87-3.18,P<0.001),wound pain(OR=3.42,95%CI:1.96-5.99,P<0.001)and pulmonary insufficiency(OR=2.74,95%CI:1.84-4.09,P<0.001).Hemoglobin≥110 mg/L(OR=0.67,95%CI:0.56-0.79,P<0.001)and forced expiratory volume in the first second(FEV1)>2 L(OR=0.22,95%CI:0.12-0.40,P<0.001)were protective factors for pulmonary infection after radical gastrectomy for gastric cancer.Conclusion The risk factors for pulmonary infection after radical gastrectomy for gastric cancer include advanced age,smoking history,perioperative blo
作者
陈曾丽
蒋运兰
彭寒梅
谢红梅
刘露
李洁
Zeng-Li CHEN;Yun-Lan JIANG;Han-Mei PENG;Hong-Mei XIE;Lu LIU;Jie LI(School of Nursing,Chengdu University of Traditional Chinese Medicine,Chengdu 610075,China;Nursing Department,Hospital of Chengdu University of Traditional Chinese Medicine,Chengdu 610072,China)
出处
《医学新知》
CAS
2023年第4期252-263,共12页
New Medicine
基金
国家重点研发计划“主动健康和老龄化科技应对”重点专项(2020YFC2003104)
四川省科技厅重点研发计划项目(20ZDYF2207)。
关键词
胃癌根治术
肺部感染
危险因素
META分析
Radical gastrectomy for gastric cancer
Pulmonary infection
Risk factors
Meta-analysis
