老年人上腹部手术后肺部并发症发生的影响因素及护理

Multivariate analysis risk factors associated with postoperative pulmonary complications following upper abdominal surgery in elder patients and nursing

目的探讨老年人上腹部手术后肺部并发症发生的围手术期危险因素及护理对策。方法收集2006年1月1日至2010年1月1日连续169例60岁以上择期全身麻醉行上腹部手术患者临床资料,包括临床表现、胸部X线检查、麻醉时间、留置鼻胃管及下床活动时间等。分析这些因素与术后肺部并发症发生的关系。结果 77例(45.6%)发生术后并发症。最常见的是肺炎(26.0%),其次是肺不张(23.4%)或气管支气管炎(22.1%)、支气管痉挛(19.5%)等。经多因素回归分析,术后留置鼻胃管、术前有呼吸道症状、麻醉时间长与术后肺部并发症发生密切相关。结论老年患者上腹部手术后易发生肺部并发症,术前进行干预及围手术期合理的护理可降低术后肺部并发症的发生率及死亡率。

Objective To determine the influence of possible perioperative risk factors on the development of postoperative pulmonary complications（POPC） after upper abdominal surgery（UAS） in elder patients.Methods A prospective survey of 167 consecutive elder patients was conducted who underwent elective UAS in a geriatric surgical unit.Each patient＇s preoperative was assessed including clinical examination,PaO2 and PaCO2 analysis,chest radiographs;operation time,duration of nasogatric catheter and mobilization time also were noted.Results Postoperative pulmonary complications were observed in 77 patients（45.6%）.The most common complication was pneumonia（26.0%）,followed by atelectasis,bronchitis,brchochospasm,pulmonary emboli and acute respiratory failure.By multivariate analysis,postoperative nasogastric intubation,preoperative respiratory symptoms;longer anesthesia duration were the most valuable risk factors for prediction of POPC.Conclusions We recommend a detailed pulmonary examination and spirometry in elder patients who will undergo UAS to identify the patients at high risk for POPC,which may help to manage perioperative care and decrease the risk of POPC.