肺切除术后肺部并发症发生的危险因素分析

Analysis of Risk Factors of Pulmonary Complications Following Lung Resection

目的分析肺切除术后肺部并发症(PPC)发生的危险因素,尽可能减少术后PPC的发生,降低病死率。方法回顾性分析2007年1月至2009年12月在我科行肺切除术302例患者的临床资料,其中男228例,女74例;年龄23～91岁,平均年龄63.38岁。统计术后各种肺部并发症的发生率,并收集术前、术中及术后相关资料和数据,采用logistic多元回归分析肺切除术后PPC发生的独立危险因素。结果围术期共死亡22例(7.28%),75例(24.83%)发生110例次PPC,最主要的PPC为胸膜腔持续漏气/支气管胸膜瘘(8.94%,27/302),院内肺炎(6.95%,21/302)和急性呼吸衰竭(6.29%,19/302)。logistic多因素分析结果显示:ASA分级≥3级(OR=2.400,P=0.020)、术后即刻气管内插管机械通气时间延长(OR=1.620,P=0.030)是肺切除术后发生PPC的独立危险因子。结论以患者一般情况和各器官功能状态为基础的ASA分级和术后机械通气时间是肺切除术后PPC的独立预测因子。对高危患者需特别注意完善术前准备,改善患者各器官功能状况,保护肺功能,术后尽量缩短机械通气时间,尽可能减少PPC的发生。

Objective To analyze possible associated risk factors of postoperative pulmonary complications （PPC） after lung resection in order to decrease the incidence and mortality of PPC.Methods We reviewed the data of 302 patients including 228 males and 74 females undergoing lung resection from January 2007 to December 2009 in our department.The age of the patients ranged from 23 to 91 years old with an average age of 63.38 years.Based on the present definition of PPC,we recorded the related information and data before,during and after the operation,and observed the rate of PPC.The independent risk factors of PPC were evaluated by multiple logistic regression analysis.Results A total of 22 patients （7.28%） died during the operation and 75 patients （24.83%） experienced 110 times of PPC,the majority of which were prolonged air leak/bronchopleural fistula （8.94%,27/302）,nosocomial pneumonia （6.95%,21/302） and acute respiratory failure （6.29%,19/302）.The results of logistic regression analysis showed that an American Society of Anesthesiology （ASA） score ≥3 （OR=2.400,P=0.020） and prolonged duration of immediate postoperative mechanical ventilation （OR=1.620,P=0.030） were independent factors associated with the development of PPC.Conclusions The ASA score based on the patients’ general condition and the function status of the main organs,and the prolonged duration of immediate postoperative mechanical ventilation are independent risk factors of PPC.In order to decrease the PPC rate,more attention should be paid to perfecting preoperative preparation,improving the function and condition of the organs,preserving pulmonary function and decreasing the duration of immediate postoperative mechanical ventilation for patients with high risk factors.