| Objective:1.To investigate the incidence of postoperative pulmonary infection in patients undergoing radical gastrectomy for gastric cancer through a cross-sectional study.2.To explore and analyze the influencing factors of postoperative pulmonary infection in patients undergoing radical gastrectomy for gastric cancer through the case-control study,so as to provide reference for the prevention of postoperative pulmonary infection.Methods:1.Using the cross-sectional study,gastric cancer patients who underwent standard radical gastrectomy in the First Hospital of Shanxi Medical University were selected from the"Gastrointestinal Surgery Database of the First Hospital of Shanxi Medical University"according to the inclusion and exclusion criteria.The relevant electronic medical records of the patients were reviewed to obtain the basic information and clinicopathological data of the patients.The basic information of the patients included general demographic characteristics(gender,age,body mass index),personal history(smoking history,drinking history),past medical history(hypertension history,diabetes history,coronary heart disease history,respiratory disease history)and family history(family history of gastric cancer).Clinical data included surgical conditions(endoscopic or not,duration of surgery,surgical method,anastomotic method)and pathological data(tumor location,degree of differentiation,pathological type,longest diameter of tumor,T stage,N stage,nerve invasion,vascular invasion),related laboratory indicators 1 week before surgery(hemoglobin,albumin,prealbumin),peripheral hematological composite indicators composed of relevant laboratory indicators 1 week before surgery(AGR,NLR,PLR,LMR,FAR,FPR,SII,PNI),postoperative complications(occurrence of early postoperative complications(during hospitalization),pulmonary infection(during hospitalization),and length of postoperative hospital stay).2.Based on the cross-sectional study,the patients were divided into pulmonary infection group and non-pulmonary infection group according to the occurrence of postoperative pulmonary infection,and a case-control study was conducted.With whether the patients had pulmonary infection(no pulmonary infection=0,pulmonary infection=1)as the dependent variable,variables with P<0.05 in univariate analysis and relevant variables reported in literature were selected to establish an unconditional logistic regression analysis model to explore the influencing factors of postoperative pulmonary infection in patients undergoing radical gastrectomy for gastric cancer.3.Epidata 3.1 double input was used for data entry,logical error correction and verification.SAS 9.2 software was used for data cleaning and data analysis.The normal distribution of quantitative data was described by mean±standard deviation(x±s),and statistical analysis was performed by t-test or ANOVA.The non-normal distribution was described by Interquartile Range(IQR),and statistical analysis was performed by rank sum test.The composition ratio(%)was used to describe the qualitative data,andx~2 test was used for comparison between groups.Multivariate unconditional logistic regression analysis was used for statistical analysis.P value of less than 0.05 was considered statistically significant.Results:1.General conditions of patients undergoing radical gastrectomy for gastric cancerA total of 639 patients with gastric cancer who underwent radical surgery were retrospectively analyzed.(1)General demographic characteristics:there were 507 males(79.34%)and 132 females(20.66%),the ratio of male to female was 3.84:1.The age ranged from 29 to 91 years old,with an average age of 64.32±10.20 years old.Among them,321 cases(50.23%)were 65 years old or above,and 318 cases(49.77%)were younger than 65 years old.(2)Personal history:255 patients(39.91%)had a history of smoking and 171 patients(26.76%)had a history of drinking.(3)Past medical history:62cases(9.70%)had diabetes mellitus,42 cases(6.57%)had coronary heart disease,85 cases(13.30%)had a history of respiratory diseases.(4)Family history:16 cases(2.50%)had family history of gastric cancer.(5)Surgical situations:539 people used laparoscopy(84.35%).The average operation duration was 251.36±88.35 minutes,of which 317 cases(49.61%)were longer than 250 minutes,322 cases(50.39%)were less than 250 minutes.(6)Pathological data:the primary tumor sites of gastric cancer were mainly concentrated in the upper part of the stomach(40.38%,258/639)and the lower part of the stomach(41.78%,267/639),and only 17.84%(114/639)in the middle part of the stomach.The longest diameter of most tumors was more than 4cm(66.40%,424/639),and 215 cases were less than 4cm(33.60%).(7)Related laboratory indicators 1 week before surgery:30.83%of gastric cancer patients were anemia before surgery.The average albumin level was 38.1±4.5g/L,and 338 cases(52.90%)were greater than or equal to 38.1g/L.The mean value of prealbumin was 223±54mg/L,and there were 353 cases(55.24%)with prealbumin greater than or equal to 223mg/L.(8)Peripheral hematological composite indexes composed of related laboratory indexes 1 week before surgery:Using ROC curve analysis to obtain the index cut-off value,LMR was greater than or equal to 3.098 in 425people(66.51%),less than 3.098 in 214 people(33.49%),FAR less than 0.091 in 454people(71.05%),more than or equal to 0.091 in 185 people(28.95%).There were 562cases(87.95%)with FPR less than 0.022 and 77 cases(12.05%)with FPR greater than or equal to 0.022.(9)Postoperative complications:299 patients had early complications,accounting for 46.79%,and 340 patients had no early complications,accounting for53.21%.There were 80 patients with pulmonary infection,accounting for 12.52%,and 559patients without pulmonary infection,accounting for 87.48%.The average postoperative hospital stay was 14±10 days.There were 225 patients who were more than or equal to 14days,accounting for 35.21%,414 patients who were less than 14 days,accounting for64.79%.There was a certain relationship between the occurrence of pulmonary infection and the postoperative hospital stay,and the postoperative hospital stay was significantly longer in the pulmonary infection group(P<0.05).2.Analysis of influencing factors about postoperative pulmonary infection in patients undergoing radical gastrectomy for gastric cancer2.1 Univariate analysis of influencing factors of postoperative pulmonary infection in patients undergoing radical gastrectomy for gastric cancerTaking the occurrence of postoperative pulmonary infection as the dependent variable,patients with gastric cancer were divided into pulmonary infection group and non-pulmonary infection group(no pulmonary infection=0,pulmonary infection=1).The results of univariate analysis showed that:There were no significant differences in age,BMI,smoking history,drinking history,hypertension history,diabetes history,family history of gastric cancer,endoscopy,surgical method,anastomosis method,degree of differentiation,pathological type,longest diameter of tumor,T stage,N stage,nerve invasion and vascular invasion.There were significant differences in gender,history of coronary heart disease,history of respiratory disease,duration of operation,tumor location,anemia,preoperative ALB size,preoperative PA size,preoperative AGR,NLR,PLR,LMR,FAR,FPR,SII,and PNI size(P<0.05).2.2 Multivariate analysis of influencing factors of postoperative pulmonary infection in patients undergoing radical gastrectomy for gastric cancerAfter controlling the significant variables in the univariate analysis and related variables reported in the literature,the unconditional logistic regression model analysis showed that male patients were more likely to have postoperative pulmonary infection(OR=3.359,95%CI:1.357-8.315).Patients with a history of respiratory diseases were more likely to have pulmonary infection(OR=2.287,95%CI:1.191-4.392).The risk of pulmonary infection in patients with operation duration of 250 minutes or more was 2.270times higher than that of patients with operation duration of less than 250 minutes(95%CI:1.325-3.888).Patients with preoperative LMR less than 3.098 were prone to pulmonary infection(OR=2.004,95%CI:1.060-3.790).The risk of pulmonary infection in patients with preoperative FAR of 0.091 or above was 2.241 times that of FAR less than 0.091(95%CI:1.053-4.770).The risk of pulmonary infection in patients with preoperative FPR of 0.022 or above was 3.339 times higher than that of FPR less than 0.022(95%CI:1.468-7.598).Conclusion:1.The incidence of postoperative pulmonary infection in patients undergoing radical gastrectomy for gastric cancer in this study was 12.52%.2.The results of unconditional logistic regression showed that male,with a history of respiratory disease,long duration of surgery,preoperative LMR<3.098,FAR≥0.091,FPR≥0.022 were risk factors for postoperative pulmonary infection in patients undergoing radical gastrectomy for gastric cancer.3.The results of this study suggest that targeted preventive measures and detailed treatment plans should be developed in advance for male patients and the patients with a history of respiratory diseases.For patients with high LMR,low FAR and low FPR,reasonable clinical intervention should be given before operation to adjust the relevant indicators to the best state.At the same time,it is essential to shorten the operation time as much as possible to prevent the occurrence of pulmonary infection after gastric cancer surgery. |
