食管癌切除术后呼吸功能衰竭的危险因素研究

Risk Factors of Postoperative Respiratory Failure in Patients with Esophageal Cancer

目的探讨食管癌切除术后呼吸功能衰竭的危险因素。方法选择2007—2010年在我院胸外科行食管癌切除术后发生呼吸功能衰竭患者193例为观察组,未发生呼吸功能衰竭患者219例为对照组。食管癌切除术后呼吸功能衰竭的危险因素分析采用单因素分析和多因素Logistic回归分析。结果单因素分析结果显示,两组患者性别,吸烟史,术前高血压、冠心病、糖尿病、贫血、肺结核合并率,肿瘤直径,TNM分期间差异均无统计学意义(P>0.05);两组患者年龄、术前慢性阻塞性肺疾病(COPD)合并率、肺功能、手术切口数量、吻合部位、手术时间、术中液体输入量、严重并发症发生率、二次手术率间差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,高龄〔OR=1.582,95%CI(1.019,2.457),P=0.041〕、中重度肺功能障碍〔OR=2.539,95%CI(1.056,6.107),P=0.037〕、2个手术切口〔OR=6.524,95%CI(2.603,16.350),P=0.000〕或3个手术切口〔OR=8.028,95%CI(1.534,42.002),P=0.014〕、手术时间长〔OR=1.650,95%CI(1.041,2.616),P=0.033〕、合并严重并发症〔OR=2.189,95%CI(1.048,4.571),P=0.037〕、二次手术〔OR=5.631,95%CI(1.096,28.935),P=0.039〕进入回归方程。结论高龄、术前中重度肺功能障碍、手术切口数量多、手术时间长、合并严重并发症、二次手术为食管癌切除术后呼吸功能衰竭的危险因素,临床上对于此类患者应予以重视。

Objective To investigate the risk factors of postoperative respiratory failure in patients with esophageal cancer.Methods 194 patients with respiratory failure and 219 without respiratory failure after resection of esophageal cancer in the department of thoracic surgery of our hospital from 2007 to 2010 were selected as observation group and control group respectively.Single factor and multiple factor Logistic regression analysis were conducted to analyze the risk factors for the postoperative respiratory failure in patients with esophageal cancer.Results Single factor analysis showed that the sex,smoking history,preoperative merging rate of hypertension,coronary heart disease,diabetes,anemia and tuberculosis,tumor diameter and TNM staging showed no statistically significant difference between the two groups（P〉0.05）.The age, preoperative merging rate of COPD,lung function,number of incision,anastomotic parts,operation time,intraoperative liquid input,incidence of severe complication and reoperation rate showed statistically significant differences between the two groups（P〈0.05）.Multiple factor Logistic regression analysis showed that advanced age[OR=1.582,95%CI（1.019,2.457）,P=0.041],moderate and severe pulmonary dysfunction[OR=2.539,95%CI（1.056,6.107）,P=0.037],two incisions[OR=6.524,95%CI（2.603,16.350）,P=0.000]or three incisions[OR=8.028,95%CI（1.534,42.002）,P=0.014],operation time[OR=1.650,95%CI（1.041,2.616）,P=0.033],severe complications[OR=2.189,95%CI（1.048,4.571）,P=0.037]and reoperation[OR=5.631,95%CI（1.096,28.935）,P=0.039]were significantly associated with the incidence of postoperative respiratory failure.Conclusion Advanced age,preoperative pulmonary function,multiple incisions,long operation time,severe complications,reoperation are risk factors for postoperative respiratory failure after the resection of esophageal cancer,and close attention should be paid to these patients in clinic.