肺结核术后早期呼吸衰竭的临床分析

Clinical analysis of early respiratory failure after operation of pulmonary tuberculosis

目的探讨导致肺结核术后早期呼吸衰竭、住院死亡的危险因素。方法回顾性收集2002年1月—2007年12月北京胸科医院肺结核行肺切除手术患者302例,术后早期发生呼吸衰竭19例作为观察组(呼衰组),未发生呼吸衰竭的283例采用随机抽样的方法选取病例共35例作为对照组(非呼衰组),比较2组各项观察指标,行单因素分析,有统计学意义的各项指标进行多因素分析,以发现肺结核术后早期发生呼吸衰竭的危险因素,并比较2组的死亡率、平均住院时间。结果302例肺结核术后患者中,19例早期发生呼吸衰竭,占手术患者的6.3%(19/302),多因素分析,年龄和手术方式是肺结核肺切除患者术后早期发生呼吸衰竭的危险因素。2组比较,术后呼吸衰竭患者的病死率明显增加,平均住院时间延长,住院费用明显增加。结论年龄的增加,手术范围的扩大增加了肺结核肺切除患者术后发生呼吸衰竭的危险,术后呼吸衰竭在增加了患者术后病死率的同时,使患者平均住院时间延长,住院费用增加。

Objective To evaluate the morbidity, mortality and risk factors of early postoperative respiratory failure after lung resection of pulmonary tuberculosis. Methods Three hundred and two patients with pulmonary tuberculosis performed by surgical resection of lung were recruited from Jan 2002 to Dec 2007 in our hospital and analyzed retrospectively. Data from observation group included 19 patients with early respiratory failure after operation and a control group included 35 patients sampled radomly from 283 patients with non-failure of respiratory were observed and carried out by univariate analysis. Multivariate analysis were carried out further for data with significant difference by univariate analysis to identify risk factors associated with early respiratory failure followed by lung resection of pulmonary tuberculosis. Hospital days and mortality were compared between the respiratory failure group and non-failure of respiratory group. Results Among 302 cases, 19 cases （6.3%） were diagnosed as respiratory failure. Logistic regression analysis showed that age and operative methods were associated with early postoperative respiratory failure. The mortality and hospital days were significantly different between the respiratory failure group and non-failure of respiratory group. Hospital costs was increasing significantly. Conclusions Patients with older age and extensive surgical range have a higher risk of respiratory failure after lung resection of pulmonary tuberculosis. Early postoperative respiratory failure does not only increase risk of mortality of patients with pulmonary tuberculosis, but to prolong hospital days and to increase hospital costs.