肺切除术后早期低氧血症的危险因素分析

Multivariate analysis of risk factors for early postoperative hypoxemia following pulmonary resection

目的探讨肺切除术后患者早期低氧血症的危险因素及其对住院时间和手术死亡率的影响。方法回顾性分析2006年1～12月我院ICU收住的262例肺切除术后当日及术后第1天患者的资料,根据第1天晨动脉血气分析检查结果,氧合指数(PaO2/FiO2)﹤300mmHg者诊断为肺切除术后早期低氧血症,分析导致肺切除术后早期低氧血症的原因,并比较低氧血症组及非低氧血症组患者的住院时间和手术死亡率。结果262例肺切除患者术后第1天晨PaO2/FiO2≤300mmHg者(低氧血症组)112例(42.7%),PaO2/FiO2﹥300mmHg者(非低氧血症组)150例(57.3%)。Logistic回归多因素分析显示,年龄、手术方式和麻醉时间与术后早期低氧血症密切相关,且均为危险因素。低氧血症组和非低氧血症组组住院时间比较[(40±21)dvs(36±20)d]有显著性差异(P﹤0.05)。两组手术死亡率(2.6%vs1.3%)比较无显著性差异(P﹥0.05)。低氧血症组气管插管率和纤维支气管镜吸痰率明显增加(P﹤0.05)。结论肺切除患者中,年龄≥65岁、手术切除范围大、麻醉时间延长者术后早期低氧血症发生率明显增加。肺切除术后低氧血症对患者手术死亡率无明显影响,术后早期ICU干预治疗可能是减少手术死亡率的原因之一。

Objective To evaluate the risk factors of early postoperative hypoxemia after pulmonary resection and to analyze impacts of risk factors on hospitalization time and short-term mortality. Methods 262 postoperative patients admited in ICU in 2006 were investigated retrospectively. Patients with PaO2/FiO2 below 300mmHg detected on the next day after operation were diagnosed as early postoperative hypoxemia following pulmonary resection. Risk factors were analyzed and hospitalization time and short-term mortality were compared between hypoxemia group and non-hypoxemia group. Results Among the 262 cases 112 （42.7%） were diagnosed as hypoxemia. Logistic regression analysis showed that age, operation range and anesthesia time were associated with early postoperative hypoxemia following pulmonary resection. There was significant difference between hypoxemia and non-hypoxemia group with regard to hospitalization time and no difference with short-term mortality. Conclusions Patients with age older than 65, larger operation range and longer anesthesia time have a higher risk for hypoxemia after pulmonary resection. Early hypoxemia does not show obvious negative impact on short-term mortality of patients. Early postoperative treatment in ICU maybe one of contributions to reduce short-term mortality.