肝癌术后肺部并发症危险因素分析

Risk factors of postoperative pulmonary complications in patients with hepatocellular carcinoma undergoing hepatic resection

目的探讨肝癌术后发生肺部并发症的相关因素分析,以期为减少或避免术后肺部并发症的发生提供思路。方法选取行肝癌根治术的肝癌患者105例,其中22例(观察组)术后发生肺部并发症,83例(对照组)术后未发生肺部并发症。比较两组患者的一般资料(性别、年龄、吸烟指数、高血压病史、呼吸系统病史、糖尿病史、术前2周呼吸道感染史、肺部听诊情况)、术前检查结果(肿瘤位置、肿瘤大小、侵犯门静脉、侵犯肝静脉、门静脉癌栓、门静脉宽度、胆红素水平、白蛋白水平、凝血酶原时间、腹水、Child评分、Child分级、ALT、AST、GPT、AFP、血红蛋白水平、血小板、血氧饱和度、ASA分级)以及手术信息(手术切口、手术方式、手术时间、麻醉时间、术中输血量)。对上述比较差异有统计学意义的相关因素,采用非条件二元多因素Logistic回归分析其与肝癌术后肺部并发症的相关性。结果单因素分析显示:低蛋白血症、手术时间、麻醉时间及术中输血量是肝癌术后发生肺部并发症(胸腔积液、肺炎)的危险因素(P<0.05或0.01)。多因素Logistic回归分析结果显示术前白蛋白水平是发生术后肺部并发症的独立危险因素(P<0.05)。结论术前白蛋白水平是肝癌术后肺部并发症的独立危险因素。

Objective To investigate the risk factors of postoperative pulmonary complications in patients with hepatocel- lar carcinoma undergoing hepatic resection. Methods One hundred and six patients with hepatocetlar carcinoma undergoing hepatectomy were included in the study. Postoperative pulmonary complications were identified in 22 patients （Observation group）, 84 patients （Control group） did not have postoperative pulmonary complications. The clinical data of two group was com- pared, including general information （sex, age, history of hypertension, respiratory system and diabetes, respiratory tract infection in 2 weeks before surgery, auscultation of lung）, preoperative examination results （tumor location, tumor size, portal vein invasion, invasion of hepatic vein, portal vein thrombosis, portal vein width, bilirubin levels, albumin levels, prothrombin time, ascites, Child score, Child classification, ALT, AST, GPT, AFP, hemoglobin levels, platelets, blood oxygen saturation and ASA classification） and surgical information （incision, operation time, anesthesia time, and intraoperative blood transfusion）. Non-conditional binary Lo- gistic regression was used to analyze the correlation of those factors with pulmonary complications following operation of hepato- cellar carcinoma. Results Univariate analysis showed that hypoproteinemia, operation time,anesthesia time and intraoperative blood transfusion were the risk factors of postoperative pulmonary complications （pleural effusion, pneumonia）（P〈0.05 or 0.01）. The multivariate logistic regression analysis identified preoperative albumin level as an independent risk factor for postoperative pulmonary complications （P〈0.05）. Conclusion Preoperative albumin level is an independent risk factor for postoperative pul- monary complications after hepatocellular carcinoma radical surgery.