老年上腹部手术围术期危险因素与术后肺部并发症的相关性研究

Multivariate analysis of perioperative risk factors associated with postoperative pulmonary complications in elder patients undergoing upper abdominal surgery

目的探讨老年上腹部手术围术期危险因素与术后肺部并发症发生的相关性。方法回顾性分析自2006年1月1日-至2010年1月1日连续收治的169例60岁以上、择期在全麻下行上腹部手术的患者,对其围术期影响呼吸功能状况的因素进行评估,包括临床表现、胸部X线检查、肺功能指标、动脉血气分析、麻醉时间、手术切口类型、留置鼻胃管及下床活动时间等,并分析这些因素与术后肺部并发症发生的关系。结果 169例患者中77例(45.6%)发生术后肺部并发症,其中最常见的是肺炎(20例),其次分别为肺不张(18例)、气管支气管炎或慢性支气管炎急性发作(17例)、支气管痉挛(15例)、急性呼吸衰竭(5例)及肺栓塞(2例)。多因素logistic回归分析显示,术后留置鼻胃管、术前有呼吸道症状、肺功能指标FEV1/FVC降低、麻醉时间长与术后肺部并发症发生密切相关。结论老年患者行上腹部手术前应进行详细的肺部检查及肺功能检测,以明确其术后肺部并发症的发生风险,并应在术前进行干预治疗,以改善肺功能,降低术后肺部并发症的发生率及死亡率。

Objective To explore the correlation between the perioperative risk factors and postoperative pulmonary complications（POPC） in elder patients undergoing upper abdominal surgery.Methods A retrospective survey of 169 elder patients（age over 60 years,received elective upper abdominal surgery under general anesthesia from Jan.1,2006 to Jan.1,2010） was conducted.The perioperative factors influencing respiratory function were evaluated,including clinical manifestations,chest X-ray,pulmonary function,arterial blood gas analysis,duration of anesthesia,incision type,duration of nasogastric tube and ambulation time.Meanwhile,the relationship between POPC and the factors mentioned above was analyzed.Results POPC were seen to occur in 77 of the 169 patients（45.6%）,and the most common complication was pneumonia（20 cases）,followed by atelectasis（18 cases）,tracheobronchitis or acute exacerbations of chronic bronchitis（17 cases）,bronchospasm（15 cases）,acute respiratory failure（5 cases） and pulmonary embolism（2 cases）.Multivariate logistic analysis showed that the postoperative nasogastric intubation,preoperative respiratory symptoms,decreased forced expiratory volume in 1st second/forced vital capacity（FEV1/FVC） and longer duration of anesthesia were the valuable risk factors for prediction of POPC.Conclusions It is recommend that a detailed preoperative pulmonary examination and pulmonary function test in elder patients who are going to have upper abdominal surgery should be done to identify the risk for POPC.Preoperative intervention therapy may be helpful to improve pulmonary function,decrease the incidence of POPC and lower mortality of the patients.