Institute of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonseiro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.
Dig Dis Sci. 2013 Feb;58(2):540-6. doi: 10.1007/s10620-012-2376-0. Epub 2012 Sep 21.
Hospital-acquired pneumonia after an endoscopic submucosal dissection (ESD) can prolong the patient's stay in the hospital, leading to greater healthcare costs. However, little is known of the characteristics and risk factors associated with this complication.
To analyze the clinical features of pneumonia after ESD and to suggest a treatment plan.
This was a retrospective study in which the cases of 1,661 consecutive patients who underwent ESD for 1,725 lesions between January 2008 and June 2011 were reviewed.
Of the 1,661 patients who underwent ESD during the study period, 38 were subsequently diagnosed with pneumonia, and an additional 18 patients exhibited lung consolidation, based on chest radiography, without respiratory signs or symptoms. The remaining 1,605 patients showed neither lung consolidation on chest radiography nor respiratory signs/symptoms. Continuous propofol infusion with intermittent or continuous administration of an opioid [odds ratio (OR) 4.498, 95 % confidence interval (CI) 2.267-8.923], a procedure time of >2 h (OR 2.900, 95 % CI 1.307-6.439), male gender (OR 2.835, 95 % CI 1.164-6.909), and age >75 years (OR 2.765, 95 % CI 1.224-6.249) were independent risk factors for pneumonia after ESD. In patients with only lung consolidation (without respiratory signs and symptoms), the length of hospital stay and prognosis were not affected by antibiotics use.
Deep sedation under continuous propofol infusion with opioid injection during ESD may be a risk factor for pneumonia.
内镜黏膜下剥离术（ESD）后发生医院获得性肺炎会延长患者的住院时间，导致更高的医疗保健费用。然而，对于这种并发症的特征和相关风险因素知之甚少。
分析 ESD 后肺炎的临床特征并提出治疗方案。
这是一项回顾性研究，对 2008 年 1 月至 2011 年 6 月期间连续 1661 例行 ESD 治疗的 1725 例患者的病例进行了回顾性分析。
在研究期间接受 ESD 的 1661 例患者中，38 例患者随后被诊断为肺炎，另有 18 例患者胸部 X 线检查显示肺部实变，但无呼吸症状或体征。其余 1605 例患者胸部 X 线检查未见肺部实变，也无呼吸症状/体征。持续输注丙泊酚联合间断或持续使用阿片类药物（比值比 4.498，95%置信区间 2.267-8.923）、手术时间>2 小时（比值比 2.900，95%置信区间 1.307-6.439）、男性（比值比 2.835，95%置信区间 1.164-6.909）和年龄>75 岁（比值比 2.765，95%置信区间 1.224-6.249）是 ESD 后肺炎的独立危险因素。仅肺部实变（无呼吸症状和体征）的患者，抗生素的使用对住院时间和预后没有影响。
ESD 期间持续输注丙泊酚联合阿片类药物静脉注射行深度镇静可能是肺炎的危险因素。
