影响经口寰枢椎术后肺部并发症发生因素的调查分析

Multifactor analysis on pulmonary complications after transoral atlantoaxial surgery

目的探讨经口寰枢椎术后肺部并发症(postoperative pulmonary complications,PPCs)的影响因素和预防措施。方法选择2005年1月～2011年12月的141例经口寰枢椎手术患者,依据术后是否发生肺部并发症分为PPCs组与非PPCs组,采用t(χ2)检验及logistic回归模型分析PPCs的影响因素。结果本组141例患者中20例出现PPCs,发生率14.18%。PPCs组与非PPCs组比较结果显示,低蛋白血症、脊髓损伤程度(Frankle分级)、气管导管留置时间3个因素为经口寰枢椎术后患者PPCs发生的独立危险因素(P<0.01)。结论 经口寰枢椎术后PPCs发生率高,临床上对于血清清蛋白<35g/L、脊髓损伤、气管导管留置时间>4d的患者应高度重视,给予相应的预防措施,减少PPCs的发生。

Objective To explore the influential factors and preventive measures of postoperative pulmonary complications （PPCs） after transoral atlantoaxial surgery. Methods The clinical data of 141 patients undergoing transoral atlantoaxial surgery from January 2005 to December 2011 were retrospectively analyzed. The patients were divided into PPCs group and non-PPCs group according to whether PPCs set on. The influential factors of PPCs were analyzed by T test and Logistic regression model. Results Of 141 patients, 20 were contracted with PPCs, with a rate of 14.18%. The comparison between PPCs group and non-PPCs group showed that hypoproteinemia, spinal injury degrees （Frankle grade） and duration of endotracheal catheterization were independent risk factors of PPCs complicated with transoral atlantoaxial surgery, with statistical significance （P 〈 0.01 ）. Conclusions The incidence of PPCs after transoral atlantoaxial surgery is high. High attention should be paid to the patients whose blood protein level is less than 35 g/L, those who suffer from spinal injury, and those who are managed with incubation more than 4 days. In this case, corresponding preventive measures should be carried out to reduce the incidence of PPCs.