食管癌、贲门癌术后急性呼吸衰竭的危险因素分析

Risk factors of postoperative acute respiratory failure in esophageal carcinoma and cardiac carcinoma patients

目的：探讨食管癌、贲门癌术后发生急性呼吸衰竭（acute respiratory failure,ARF）的危险因素,为针对性预防其发生提供临床指导依据。方法：将1995年1月～2005年1月期间食管癌、贲门癌术后发生ARF的42例患者临床资料,与按1∶2比例随机抽取的同期手术后未发生ARF的84例食管癌、贲门癌患者的资料做对照,应用Logistic回归分析比较两组患者的年龄、性别、吸烟指数、术前肺功能、术前有无肺部合并症和其它合并症、术前有无低蛋白血症、吻合口位置、手术时间、术后是否镇痛、术后有无其它并发症等与术后发生ARF的相关强度,推测可能导致术后ARF发生的危险因素。结果：患者术前肺功能中重度受损、吸烟指数〉400支/年、术前有肺部合并症和手术时间〉3h,四个因素与术后ARF发生有显著相关性（P〈0.05）。结论：术前改善低肺功能、早期戒烟、积极治疗肺部合并症、提高手术技巧,缩短手术时间是预防和减少术后ARF发生的重要环节之一。

Objective： To analyze the risk factors of postoperative acute respiratory failure in esophageal carcinoma and cardiac carcinoma patients. Methods： Form January 1995 to January 2005, 42 patients with acute respiratory failure （acute respiratory failure group） and 84 random sampling（control group） after esophagectomy and cardiectomy were studied. Age, sex, smoke index, preoperative respiratory function, preoperative pulmonary and the other complications, hypoproteinemia, the site of anastomosis, duration of operation, postoperative analgesia, postoperative other complications were compared by Logistic Regression analysis. Results： The risk factors of postoperative acute respiratory failure included bad preoperative pulmonary function, smoke index more than 400, preoperative pulmonary complications and duration of operation more than 3 hours （P〈0.05）. Conclusion： To prevent the occurrence of postoperative acute respiratory failure, improvement preoperative pulmonary function, early withdrawal cigarettes, treatment pulmonary complication and decurtate operation time should be helpful.