Zhang Yunxiao, Li Shuo, Yan Chao, Chen Jiheng, Shan Fei
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China.
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), The First Department of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China.
Cancer Manag Res. 2021 Oct 8;13:7723-7734. doi: 10.2147/CMAR.S333414. eCollection 2021.
In patients undergoing surgical resection for gastric cancer, postoperative complications-in particular, postoperative infections-remain an important problem and can result in delayed recovery and increased postoperative mortality.
To investigate the association between perioperative anesthesia management and postoperative infectious complications in patients undergoing resection for gastric cancer.
Retrospective cohort study.
A single-center study performed from April 1, 2015, to June 30, 2018, at Peking University Cancer Hospital.
Patients who underwent resection for gastric cancer.
Demographic information, perioperative data (including anesthesia-related data, surgery-related data, and cancer diagnosis), and information on postoperative recovery were recorded. The primary outcome was incidence of postoperative infection; the secondary outcome was length of hospital stay. The associations between perioperative factors and postoperative infectious complications were analyzed using multivariable logistic regression models and the classification tree method.
A total of 880 patients were included in the study; of these, 111 (12.6%) had postoperative infectious complications during hospitalization, including 78 surgical site infections and 62 remote infections. After correction for confounding factors on logistic multivariable analysis, perioperative use of glucocorticoids was associated with a lower incidence of postoperative infection (hazard ratio 0.968, 95% confidence interval 0.939 to 0.997, =0.029), and intraoperative systolic blood pressure <90 mmHg for >10 min was associated with a higher incidence of postoperative infection (hazard ratio 2.112, 95% confidence interval 1.174 to 3.801, =0.013). In addition, older age, preoperative hypoproteinemia, and total gastrectomy were identified as independent predictors of postoperative infection.
For patients with gastric cancer, perioperative use of glucocorticoids and avoiding intraoperative hypotension may decrease the incidence of postoperative infectious complications.
在接受胃癌手术切除的患者中，术后并发症，尤其是术后感染，仍然是一个重要问题，可能导致恢复延迟和术后死亡率增加。
探讨胃癌切除患者围手术期麻醉管理与术后感染性并发症之间的关联。
回顾性队列研究。
2015年4月1日至2018年6月30日在北京大学肿瘤医院进行的单中心研究。
接受胃癌切除术的患者。
记录人口统计学信息、围手术期数据（包括麻醉相关数据、手术相关数据和癌症诊断）以及术后恢复信息。主要结局是术后感染的发生率；次要结局是住院时间。使用多变量逻辑回归模型和分类树方法分析围手术期因素与术后感染性并发症之间的关联。
本研究共纳入880例患者；其中，111例（12.6%）在住院期间发生术后感染性并发症，包括78例手术部位感染和62例远处感染。在逻辑多变量分析中校正混杂因素后，围手术期使用糖皮质激素与术后感染发生率较低相关（风险比0.968，95%置信区间0.939至0.997，P=0.029），术中收缩压<90 mmHg持续>10分钟与术后感染发生率较高相关（风险比2.112,95%置信区间1.174至3.801，P=0.013）。此外，年龄较大、术前低蛋白血症和全胃切除术被确定为术后感染的独立预测因素。
对于胃癌患者，围手术期使用糖皮质激素并避免术中低血压可能会降低术后感染性并发症的发生率。
