胃十二指肠手术后呼吸系统并发症的危险因素探讨

Risk factors for postoperative pulmonary complications after gastroduodenal operation

目的探讨胃、十二指肠手术患者术后发生呼吸系统并发症(postoperativepulmonarycomplications,PPC)的危险因素。方法对1999年12月至2003年12月接受胃十二指肠手术的连续病例共508例患者的临床资料进行回顾性分析。采用单因素、多因素Logistic回归分析的方法筛选与发生PPC相关的危险因素。结果508例患者有131例(25.8%)发生PPC。多因素Logistic回归分析筛选出与PPC有关的危险因素为:年龄(OR=1.052)、术前伴存呼吸疾病(OR=2.915)、血清白蛋白水平(OR=0.995)、术中气管插管时间(OR=1.005)、保留鼻胃管时间(OR=1.059)、术后机械通气时间(OR=1.367)。得出Logistic回归预测方程为:P(1)=1/犤1+e-(-3.780+0.051×Y+1.086×Rd-0.005×Alb+0.005×Dtc+0.057×Dnt+0.312×Dmv)犦。结论高龄、有基础呼吸疾病、血清白蛋白水平低于正常、术中和术后留置胃管、气管插管、机械通气时间长者,易于发生PPC。

Objective To investigate the risk factors for postoperative pulmonary complications （PPC） after gastroduodenal operation. Methods From December 1999 to December 2003, clinical data of 508 patients undergoing gastroduodenal operation were analyzed retrospectively. Risk factors for PPC were screened. Results The complication rate of PPC was 25.8% （131/508）. Multivariate logistic regression analysis revealed that age （OR = 1. 052）, history of respiratory diseases （OR = 2.915 ）, serum albumin level （OR = 0. 995）, length of intratracheal intubation （OR = 1. 005）, length of nasogastric intubation （OR = 1.059） and length of postoperative mechanical ventilation （OR = 1. 367） were risk factors for PPC. Conclusion Patients with old age, lower serum albumin level, intraoperative or postoperative nasogastric intubation, intratracheal intubation or long-term mechanical ventilation were more prone to develop PPC.