老年人腹部手术后肺脏并发症的临床研究

Clinical study on postoperative pulmonary complication after abdominal operation in elder patients

目的 探讨老年人腹部手术后肺脏并发症的影响因素.方法 回顾性分析60岁以上老年人择期腹部手术患者95例的临床资料（分为肺脏并发症组和无肺脏并发症组）,分析2组患者的年龄、性别、吸烟史、手术时间、手术部位、术前肺功能指标及麻醉方式7个相关因素,以及这些因素与术后肺脏并发症的关系.结果 95例患者中19例发生肺脏并发症;肺脏并发症组患者手术时间（3.4±1.1）h,明显高于无肺脏并发症组患者手术时间（2.6±0.9）h（P＜0.05）.肺脏并发症组患者术前肺功能测定中,第1秒用力呼气量占预计值百分比（FEV1%）为（59.2±9.5）%,第1秒用力呼气量与用力肺活量比值（FEV1/FVC）为（61.3±7.7）%,最大通气量占预计值百分比（MVV%）为（59.3±8.6）%,与无肺脏并发症组比较[FEV1%：（79.7±11.5）%、FEV1/FVC：（73.2±8.3）%、MVV%：（74.2±6.4）%],差异均有统计学意义（P均＜0.05）.肺脏并发症组患者上腹部手术、全麻术后发生肺脏并发症的危险性增加,与无肺脏并发症组比较差异均有统计学意义（P＜0.05或P＜0.01）.结论 手术时间、手术部位、术前肺脏功能异常及麻醉方式可能是老年人腹部手术患者发生术后肺脏并发症的危险因素.

Objective To discuss the influential factors of postoperative pulmonary complications in elder patients accepted abdominal operation. Methods The clinical data of 95 cases accepted abdominal operation were analyzed retrospectively,and all the patients aged over 60. These patients were divided into two groups based on whether they had pulmonary complications or not. Seven relative factors including the age,sex,smoking history,surgery duration ,operation place,pulmonary function,anesthesia were analyzed and the relationship between these factors and the incidence of postoperative pulmonary complications were explored,too. Results Among the 95 patients,19 cases had pulmonary complications. The surgery duration in patients with pulmonary complications （（3.4 ± 1.1）h）were significantly higher than in those without pulmonary complications （（2. 6 ± 0. 9）h）（P 〈0.05）. We also found significant differences in the comparison of FEV1%（59.2 ±9.5）,FEV1/FVC（61.3 ±7.7）% ,MVV%（59.3 ±8.6）% in the group with pulmonary complications,with FEV1%（79.7 ± 11.5）%、FEV1/FVC（73.2 ±8. 3）% 、MVV%（74. 2 ±6. 4）% in the group without pulmonary complications. The epigastric operation and general anesthesia before operation were risk factors for post-operative pulmonary comphcations（P 〈0. 05）. Conclusions Surgery duration,operation place,pulmonary dysfunction and anesthesia may be the risk factors of pulmonary complications after abdominal operation.