背景 脑干肿瘤在儿童颅内肿瘤中发生率较高，其术后肺部并发症的发生率较高，影响患儿预后转归。目的 研究儿童患者（0-15岁）择期行脑干原发肿瘤切除术后肺部并发症的发生情况及相关因素。方法 回顾性观察2016年1月至2018年6月在首都医科大学附属北京天坛医院神经外科择期在全身麻醉下行开颅脑干肿瘤切除术且年龄为0-15岁的患者，共计103例。收集患者术前、术中、术后相关资料，调查术后肺部并发症的发生情况，相关因素对肺部感染的影响，并建立回归模型。 结果 103例患者中有女性52例(50.5%)，男性51例(49.5%)。46例患者发生肺部感染(44.7%)，其中16例（34.8%）出现呼吸衰竭，4例（8.7%）合并肺不张。发生肺部感染的患者住院时间和住院费用明显高于无肺部感染的患者。术后肺部感染的可能诱发因素包括：出量（单位体重），尿量（单位体重），手术时间，延髓肿瘤，术后一日血浆白蛋白值，术后需呼吸机支持。使用多因素logistic回归分析儿童脑干肿瘤术后肺部炎症发生的独立危险因素包括：手术时间(OR, 1.008, 95%CI 1.001-1.015), 延髓肿瘤 (OR, 3.312, 95%CI 1.096-8.947)，术后呼吸机支持 (OR, 8.042, 95%CI 1.485-43.545)。 结论 儿童患者在接受择期脑干原发肿瘤切除术后，肺部感染的发生率高达44.7%，应加强重视与围术期管理，其中长时间手术, 延髓肿瘤，术后呼吸机支持是导致术后肺部感染发生率增加的独立危险因素。
【Abstract】Objective To analyze the postoperative pulmonary infection and the associated factors in children patients (0-15 years) undergoing elective brain stem tumors resections. Methods A retrospective analysis was conducted on 103 patients who underwent elective operation of brain stem tumors from January 2016 to June 2018 admitted in Beijing Tiantan Hospital, Capital Medical University. The preoperative, intraoperative and postoperative data were collected to study the association of the risk factors with the incidence of postoperative pulmonary complications and postoperative pulmonary infections. Results: A total of 103 patients were enrolled in this study. The average age were 7.9±3.6 years. The youngest patient was 2 years old. A total of 46 patients had pulmonary infection (44.7%). The variables associated with postoperative pneumonia included output volume per kilogram, urine volume per kilogram, operation time, Medulla oblongata tumor, serum albumin and postoperative application of ventilator. The risk factors for postoperative pulmonary infection based on multi-variate logistic regression analyses were as follows: operation time(OR, 1.008, 95%CI 1.001-1.015), Medulla oblongata tumor (OR, 3.312, 95%CI 1.096-8.947)，and postoperative application of ventilator (OR, 8.042, 95%CI 1.485-43.545). Conclusion The incidence of postoperative pulmonary infection in children patients undergoing elective brainstem tumor resection is up to 44.7%. More and perioperative attention should be paid to it. Operation time, Medulla oblongata tumor, and postoperative application of ventilator are independent risk factors for pulmonary infections after brain stem surgery in children.ldren.
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