Risk factors of nosocomial infection during perioperative period in patients with lung cancer and influence of common used anesthetic drugs on the prognosis
Chen Wenhua
Chen Mingjun
Zhang Xiaoying
Chen Zhiqiang
Zheng Jianbo
Zhang Yuhong
Xu Hongzhan
Abstract：Objective To analyze risk factors of nosocomial infection during perioperative period in patients with lung cancer;to analyze effects of different anesthetic drugs on expressions of soluble interleukin-2 receptor(SIL-2R),interleukin-6(IL-6),tumor necrosis factor-α (TNF-αx),postoperative cognitive function and analgesic effects.Methods Totally 272 patients with lung cancer undergoing surgical resection were enrolled from January 1,2014 to September 1,2016 in Puning Traditional Chinese Medicine Hospital.Risk factors of nosocomial infection during perioperative period were analyzed through multivariatc logistic regression method.Effects of different anesthetic drugs(is0flurane,sevoflurane,propofol plus remifentanil) on levels of SIL-2R,IL-6,TNF-α and scores of the Mini-Mental State Examination(MMSE) and Pain Numerical Rating Scale (NRS) were analyzed.Results Nosocomial infection occurred in 80 cases,the infection rate was 29.4％.Age ＞ 60 years,duration of operation ＞ 4 h,intraoperative blood loss ＞ 400 ml and length of hospital stay ＞ 15 d were independent risk factors of nosocomial infection[odds ratio =2.974,95％ confidence interval:1.159-6.376,P =0.042;odds ratio =3.654,95％ confidence interval:1.432-3.865,P =0.002;odds ratio =3.712,95％ confidence interval:2.513-7.456,P ＜ 0.001;odds ratio =2.324,95 ％ confidence interval:1.314-9.735,P =0.015] (P ＜ 0.05).In 80 cases of nosocomial infection,24 patients had isoflurane anesthesia(group A),28 patients had sevoflurane anesthesia (group B) and 28 patients had propofol plus remifentanil (group C).The level of SLR-2R when stitching incision in group C was significantly higher than that in group A and B[(634 ± 120)kU/L vs (550 ± 128),(559 ± 126)kU/L] (P ＜0.05).Levels of IL-6 and TNF-α when stitching incision and at 12 h after operation in group C were significantly higher than those in group A and B [IL-6:(160 ± 37),(163 ± 30) ng/L vs (104 ± 11) ng/L;(101±13),(111 ±14)ng/L vs (73 ±9)ng/L;TNF-α:(74 ±12),(83 ±6)ng/L vs (50 ± 11)ng/L;(78 ± 7),(70 ± 9) ng/L vs (48 ± 10) ng/L] (P ＜ 0.05).The score of MMSE 1 h after operation in group C was significantly lower than that in group A and B [(19.5 ± 1.2) points vs (27.3 ± 2.1),(28.1 ± 1.9) points] (P ＜ 0.05);scores of NRS 30 min,1 h after operation in group C were significantly lower than those in group A and B [(4.7±1.6)points vs (2.9 ±2.0),(2.1 ±1.2)points;(4.9 ±1.1)points vs (3.2 ±1.0),(3.5 ± 1.4)points] (P ＜0.05).Conclusions Age ＞60 years,intraoperative blood loss ＞400 ml,duration of operation ＞ 4 h,length of hospital stay ＞ 15 d are independent risk factors of nosocomial infection during perioperative period of lung cancer resection.Sevofhtrane has a better effect on inhibiting expressions of SIL-2R,IL-6 and TNF-α;isoflurane and sevoflurane have better postoperative analgesic effects and patients generally have higher MMSE scores.
Keywords：Lung neoplasmsPerioperative periodNosocomial infectionRisk factorsIsofluraneSevofluraneCytokinesPostoperative cognitive function
Publication Date：2017-09-30
Online Publishing Date：2026-09-14(First online date of this platform, not the publication date of the document)
Pages：5( 1321-1325 )