肺癌患者胸外手术前治疗牙周基础疾病对预防术后肺炎发生的效果评价

doi:10.6040/j.issn.1671-7554.0.2021.1094

摘要/Abstract

摘要： 目的探讨术前牙周病基础治疗对行胸外科手术的肺癌伴牙周疾病者术后肺炎(POP)发生的影响。方法将符合纳入与排除标准、拟接受胸外科手术的肺癌伴牙周疾病患者,分为实验组和对照组。实验组术前行牙周病基础治疗,对照组保持患者原有口腔卫生习惯。两组人群均在术后随访满30 d,分析30 d内的POP发生率及有关因素。结果实验组(n=206)和对照组(n=190)基线特征一致。实验组POP发生率为2.91%,低于对照组14.21%(χ2=16.52,P<0.001)。牙周病基础治疗可以预防POP的发生(OR=0.181,95%CI:0.078~0.411)。术前诊断为牙龈炎、牙周炎的患者,实验组POP发生率均低于对照组(P<0.05)。两组人群中均有随牙周疾病严重程度的增加,POP发生率升高的趋势(P<0.05)。无论行开胸术者(楔形切除、肺叶切除、肺段切除、袖状切除)还是行电视辅助胸腔镜手术者,实验组POP发生率均低于对照组(P<0.05)。结论术前牙周病基础治疗可以降低行胸外科手术的肺癌伴牙周疾病者POP发生率。

关键词: 牙周病基础治疗, 肺癌, 术后肺炎, 临床试验

Abstract: Objective To investigate the effects of periodontal basic therapy on postoperative pneumonia(POP)in patients with lung cancer undergoing thoracic surgery. Methods Patients with lung cancer and periodontal disease who met the inclusion and exclusion criteria were divided into the experimental group and control group. The experimental group received periodontal basic therapy before thoracic surgery, while the control group maintained the oral hygiene habits. All subjects were followed up for 30 days, and the incidence of POP and related factors were analyzed. Results There were 206 cases in the experimental group and 190 cases in the control group. The incidence of POP in the experimental group was 2.91%, which was lower than that in the control group 14.21%(χ2=16.52, P<0.001). Logistic regression results showed that periodontal basic therapy had a protective effect on POP(OR=0.181, 95%CI=0.078-0.411). The incidence of POP in the experimental group was lower than that in the control group(P<0.05)in patients with gingivitis and periodontitis. In both groups, the incidence of POP increased with the severity of periodontal disease(P<0.05). The incidence of POP in the experimental group was significantly lower than that in the control group in those who underwent thoracotomy(wedge resection, lobectomy, segmental resection, sleeve resection)or video-assisted thoracoscopic surgery(P<0.05). Conclusion Periodontal basic therapy can reduce the incidence of POP in patients with lung cancer and periodontal disease before thoracic surgery.

Key words: Periodontal basic therapy, Lung cancer, Postoperative pneumonia, Clinical trial

中图分类号:

R781.4

韩靖,贾春玲. 肺癌患者胸外手术前治疗牙周基础疾病对预防术后肺炎发生的效果评价[J]. 山东大学学报 (医学版), 2022, 60(9): 113-118.

HAN Jing, JIA Chunling. Effects of periodontal basic therapy on postoperative pneumonia in patients with lung cancer before thoracic surgery[J]. Journal of Shandong University (Health Sciences), 2022, 60(9): 113-118.

参考文献

[1] 刘慧敏, 周乾宇, 贾善群, 等. 2004~2018年中国肺癌死亡趋势分析及预测[J]. 中国预防医学杂志, 2021, 22(12): 913-919. LIU Huimin, ZHOU Qianyu, JIA Shanqun, et al. Death trends of lung cancer in China from 2004—2018[J]. Chinese Preventive Medicine, 2021, 22(12): 913-919.
[2] 葛均波, 徐永健, 王辰. 内科学[M].9版. 北京: 人民卫生出版社, 2020.
[3] Yao L, Luo J, Liu L, et al. Risk factors for postoperative pneumonia and prognosis in lung cancer patients after surgery: A retrospective study[J]. Medicine(Baltimore). 2021, 100(13): e25295. doi:10.1097/MD.0000000000025295.
[4] Stéphan F, Boucheseiche S, Hollande J, et al. Pulmonary complications following lung resection: a comprehensive analysis of incidence and possible risk factors[J]. Chest, 2000, 118(5): 1263-1270.
[5] 中华预防医学会医院感染控制分会第四届委员会,重点部位感染防控学组. 术后肺炎预防和控制专家共识[J]. 中华临床感染病杂志, 2018, 11(1): 11-19. Group of Key Site Infection Control, Nosocomial Infection Control Commission, Chinese Preventive Medicine Association. Expert consensus on prevention and control of postoperative pneumonia[J]. Chinese Journal of Clinical Infectious Diseases, 2018, 11(1): 11-19.
[6] Heo SM, Haase EM, Lesse AJ, et al. Genetic relationships between respiratory pathogens isolated from dental plaque and bronchoalveolar lavage fluid from patients in the intensive care unit undergoing mechanical ventilation[J].Clin Infect Dis, 2008, 47(12): 1562-1570.
[7] Hyung-Suk Yoon, Wanqing Wen, Jirong Long, et al. Association of oral health with lung cancer risk in a low-income population of African Americans and European Americans in the Southeastern United States[J]. Lung Cancer, 2018, 127: 90-95. doi: 10.1016/j.lungcan.2018.11.028.
[8] Jia C, Sun M, Wang W, et al. Effect of oral plaque control on postoperative pneumonia following lung cancer surgery[J]. Thorac Cancer, 2020, 11(6): 1655-1660.
[9] Ishimaru M, Matsui H, Ono S, et al. Preoperative oral care and effect on postoperative complications after major cancer surgery[J]. Br J Surg, 2018, 105(12): 1688-1696.
[10] Iwata E, Hasegawa T, Yamada SI, et al. Effects of perioperative oral care on prevention of postoperative pneumonia after lung resection: multicenter retrospective study with propensity score matching analysis[J]. Surgery, 2019, 165(5): 1003-1007.
[11] Ishimaru M, Matsui H, Ono S, et al. Preoperative oral care and effect on postoperative complications after major cancer surgery[J]. Br J Surg, 2018, 105(12): 1688-1696.
[12] Savardekar A, Gyurmey T, Agarwal R, et al. Incidence, risk factors, and outcome of postoperative pneumonia after microsurgical clipping of ruptured intracranial aneurysms[J]. Surg Neurol Int, 2013, 4: 24. doi: 10.4103/2152-7806.107894.
[13] Chen W, Zheng R, Baade PD, et al. Cancer statistics in China[J]. CA Cancer J Clin, 2016, 66(2): 115-132.
[14] Torre LA, Siegel RL, Ward EM, et al. Global cancer incidence and mortality rates and trends - an update[J]. Cancer Epidemiol Biomarkers Prev, 2016, 25(1): 16-27.
[15] Yang Q, Luo LC, Li FM, et al. Survival outcomes of radiofrequency ablation compared with surgery in patients with early-stage primary non-small-cell lung cancer: a meta-analysis[J]. Respir Investig, 2022, 60(3): 337-344.
[16] 李刚, 王健生, 秦思达, 等. 布地奈德联合氨溴索氧化驱动雾化吸入预防成人开胸术后肺炎的临床疗效[J]. 北京大学学报(医学版), 2018, 50(5): 840-844. LI Gang, WANG Jiansheng, QIN Sida, et al. Clinical study of the oxygen drive aerosol inhalation with budesonide and ambroxol in the prevention of adult post-thoracotomy pneumonia[J]. Journal of Peking University(Health Sciences), 2018, 50(5): 840-844.
[17] Villeneuve PJ. Interventions to avoid pulmonary complications after lung cancer resection[J]. J Thorac Dis, 2018, 10(Suppl 32): S3781-S3788.
[18] Lakoh S, Yi L, Sevalie S, et al. Incidence and risk factors of surgical site infections and related antibiotic resistance in Freetown, Sierra Leone: a prospective cohort study[J]. Antimicrob Resist Infect Control, 2022, 11(1): 39.
[19] 许缤, 陈红岩, 孙嫣, 等. 胸外科手术后医院获得性肺炎危险因素分析[J]. 中华医院感染学杂志, 2012, 22(1): 64-66. XU Bin, CHEN Hongyan, SUN Yan, et al. Risk factors of hospital-acquired pneumonia after thoracic surgery[J]. Chinese Journal of Nosocomiology, 2012, 22(1): 64-66.
[20] Vieira Colombo AP, Magalhães CB, Hartenbach FA, et al. Periodontal-disease-associated biofilm: a reservoir for pathogens of medical importance[J]. Microb Pathog, 2016, 94(5): 27-34.
[21] Nishino T, Yoshida T, Inoue S, et al. Perioperative oral management for esophageal cancer and lung cancer surgery[J]. Nihon Geka Gakkai Zasshi, 2017, 118(2): 155-160.
[22] 孟焕新. 牙周病学[M]. 4版. 北京: 人民卫生出版社, 2022.
[23] Qiu T, Zhao Y, Xuan Y, et al. Robotic sleeve lobectomy for centrally located non-small cell lung cancer: a propensity score-weighted comparison with thoracoscopic and open surgery[J]. J Thorac Cardiovasc Surg, 2020, 160(3): 838-846.
[24] Lewis RJ, Caccavale RJ, Sisler GE, et al. One hundred consecutive patients undergoing video-assisted thoracic operations[J]. Ann Thorac Surg, 1992, 54(3): 421-426.
[25] Rauma V, Andersson S, Robinson EM, et al. Thoracotomy and VATS surgery in local non-small-cell lung cancer: differences in long-term health-related quality of life[J]. Clin Lung Cancer, 2019, 20(5): 378-383.
[26] 张大勇. 电视辅助胸腔镜手术与开胸手术对非小细胞肺癌患者术后免疫功能的影响[J]. 湖南师范大学学报(医学版), 2021, 18(1): 124-127. ZHANG Dayong. The effect of video-assisted thoracoscopic surgery and thoracotomy on postoperative immune function of patients with non-small cell lung cancer[J]. Journal of Hunan Normal University(Medical Sciences), 2021, 18(1): 124-127.

相关文章 15

[1]	高中霞,张铭,樊明德,谭晨阳,王梦迪,王超,樊跃飞,丁守銮,王成伟. 伽玛刀治疗81例肺癌脑转移瘤的疗效及预后因素[J]. 山东大学学报 (医学版), 2022, 60(8): 44-49.
[2]	王福立,孙银萍,秦杰,荣建胜. DC-CIK细胞联合EGFR-TKI治疗35例老年晚期EGFR突变肺癌的效果[J]. 山东大学学报 (医学版), 2022, 60(7): 110-117.
[3]	秦静,杨飞,陈谦,夏涵岱,刘延国,王秀问. 晚期驱动基因阴性、PD-L1表达阴性非鳞非小细胞肺癌一线治疗方案的网状Meta分析[J]. 山东大学学报 (医学版), 2022, 60(7): 74-82.
[4]	陈兆波,方敏,薛浩然,刘春艳. 去泛素化酶USP35促进非小细胞肺癌细胞迁移和侵袭[J]. 山东大学学报 (医学版), 2022, 60(4): 30-37.
[5]	彭岳,刘雷,李原,别凤龙,周博伦,李润泽,冀瑛,白广宇,谭锋维,高禹舜,牟巨伟,薛奇,邱斌,高树庚. 解剖性部分肺叶切除术及围术期加速康复外科的临床综合应用[J]. 山东大学学报 (医学版), 2022, 60(11): 44-53.
[6]	高会江,魏煜程. 微创袖式肺叶切除手术:免疫治疗时代的机遇和挑战[J]. 山东大学学报 (医学版), 2022, 60(11): 23-27.
[7]	韩丁培,严越,曹羽钦,孙昕,胡琰霞,汪敏娴,罗艳,施咏梅,谢青,杭钧彪,李鹤成. 加速康复外科理念在胸外科临床实践指导的瑞金医院专家共识[J]. 山东大学学报 (医学版), 2022, 60(11): 11-16.
[8]	高树庚. 加速康复外科在肺癌围术期管理中的应用[J]. 山东大学学报 (医学版), 2022, 60(11): 1-10.
[9]	刘会宁,彭军,任迎春,杨光,王文豪,刘金锋,田勍. 34例胸腔镜下肺楔形切除与21例肺段切除对位于肺段P区的ⅠA1期非小细胞肺癌治疗比较[J]. 山东大学学报 (医学版), 2022, 60(11): 38-43.
[10]	丁子琛,王浩桦,周立雯,丛慧文,李承圣,包绮晗,杨毅,王廉源,王素珍,石福艳. 基于贝叶斯累加回归树模型的非小细胞肺癌患者个性化疗效研究[J]. 山东大学学报 (医学版), 2022, 60(10): 92-98.
[11]	于金明,颜薇薇,陈大卫. 肺癌放射免疫新实践[J]. 山东大学学报 (医学版), 2021, 59(9): 1-8.
[12]	张喜琴,祝守慧,刘宁,王玉,陈家帧,胡旭东. PEG-rhG-CSF对80例小细胞肺癌同步放化疗预防中性粒细胞减少的临床观察[J]. 山东大学学报 (医学版), 2020, 58(12): 43-46.
[13]	张煜,唐兴,马海涛,蒋威. 荧光染色技术在胸腔镜肺段切除术中的价值[J]. 山东大学学报 (医学版), 2020, 58(12): 38-42.
[14]	刘小璟,夏西燕,肖珂,陈文丹,庄学伟. 外泌体lncRNA OGFRP1在84例非小细胞肺癌中的表达及临床意义[J]. 山东大学学报 (医学版), 2020, 58(11): 71-75.
[15]	徐鹏飞,朱玲,万云焱,姚周虹,李德志,王聪,翟聪聪,李文,林殿杰. 重组人血管内皮抑素联合重组人干扰素γ对小鼠Lewis肺癌移植瘤的作用[J]. 山东大学学报 (医学版), 2020, 58(1): 1-5.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed