阻塞性肺疾病危险因素与术后肺部并发症关系的研究

Study of the relation between dangerous factors and postoperative pulmonary complications in perioperative patients combined with chronic obstructive pulmonary diseases

目的分析围手术期合并慢性阻塞性肺疾病(COPD)者的自身因素、手术因素与手术后肺部并发症(PPC)发生的关系及术前各项肺功能指标和动脉血氧分压(PaO2)与PPC的关系。方法对2002年9月至2004年11月中国医科大学附属第一医院重症医学科收治的54例围手术期COPD病人按年龄、体重指数(BMI)、手术时间及手术部位分别分组,对不同组间PPC的发生率进行χ2检验;利用SPSS11.12统计软件对术前动脉血氧分压(PaO2)和肺功能指标与PPC间的关系、对术前动脉血氧分压(PaO2)和肺功能指标与术后机械通气(MV)时间的关系进行多元相关分析。结果54例病人中30例(55.6%)发生PPC。年龄>70岁组与年龄≤70岁组的PPC发生率差异无显著性意义;BMI≥24组的PPC发生率显著高于BMI<24组;手术时间≥2h组的PPC发生率显著高于<2h组;上腹部手术组PPC的发生率显著高于下腹部组。术前PaO2和各肺功能指标与PPC的发生呈负相关趋势;而肺通气功能的各项指标与术后机械通气(MV)时间也呈负相关趋势。结论围手术期COPD病人,BMI≥24、手术时间≥2h者,上腹部手术者,术前肺通气功能较差者,PPC的发生率高;术前阻塞性肺通气功能障碍越重,MV时间越长。

Objective To analyze the relation between surgery and postoperative pulmonary complications （PPC） and relation between preoperative every lung function index, artery oxygen pressure and PPC in abdominal perioperative patients. Methods Fifty-four abdominal perioperative patients combined with chronic obstructive pulmonary diseases （COPD） admitted between September 2002 and November 2004 in the First Affiliated Hospital of Chinese Medical Universtiy were divided into groups according to their ages, BMI, operation hours and operated site respectively. The incidence of PPC in each groups were compared by X2 test. SPSS11.12 software was used for multivariate analysis between preoperative lung function, artery oxygen pressure and PPC incidence and between preoperative lung function, artery oxygen pressure and postoperative mechanical ventilation time. Results The incidence of PPC was 55.6 （30/54）. The incidence of PPC had not significant difference between 〉70 years old group and ≤70 years old group （ P 〉0. 05）. The incidence of PPC in patients with BMI ≥24 was significantly more than that in patients with BMI 〈 24 （ P 〈 0. 05 ）. The incidence of PPC in patients with operation time ≥ 2h was significantly more than that in patients with operation time 〈 2h （ P 〈 0. 05 ）. The incidence of PPC in patients performed upper abdomen operation was significantly more than that in patients performed lower abdomen operation （ P 〈 0.05 ）. Preoperative arterial partial pressure of oxygen （ PaO2 ） and lung function were negative correlated with PPC incidence. The lung function was negative correlated with postoperative mechanical ventilation （MV） time. Conclusion The incidence of PPC is high in the abdominal perioperative patients combined with COPD. PPC incidences in patients Overweighting （BMI ≥24）, in patients with operation time ≥2h and in patients with upper abdominal operation are high. The worse the preoperative lung function, the higher the PPC incidence. The worse the preoperative lung function, the longer the postoperative MV time.