肺癌术后发生急性呼吸窘迫综合征的相关危险因素分析

Risk factors for acute respiratory distress syndrome after lung cancer resection

目的:通过对肺癌术后发生急性呼吸窘迫综合征(ARDS)相关危险因素的分析,评估和预测肺癌患者术后发生ARDS的可能性。方法:采用连续的回顾性病例对照研究,分析在我院行肺癌根治术患者的资料。发生ARDS的患者作为病例组,分析年龄、手术方式和切除范围因素;以年龄、手术切除范围等已知的危险因素为匹配条件选出对照组,比较两组患者术前、术中、术后的一些相关指标。结果:873例在我科行肺癌根治术的患者中,术后发生ARDS的43例(4.93%)。是否胸腔镜手术对ARDS的发生无统计学意义,但年龄及切除范围对ARDS的发生有统计学意义。病例组和对照组在性别、吸烟史、肿瘤分期上差异无统计学意义;单因素及多因素分析发现,术后肺功能预测值、围术期晶体输液量、手术时间、双肺通气量、单肺通气时间、单肺通气量、单肺气道压两组差异有统计学意义,而术后肺功能预测值及围术期晶体输液量是独立的危险因素且具有预测价值。结论:肺癌手术患者术后肺功能预测值低且围术期晶体输液量大者容易发生ARDS。

Objective： To analyze the risk factors of postoperative acute respiratory distress syndrome（ ARDS） in patients with lung cancer,and to predict the possibility of the development of ARDS. Methods： A retrospective case-control study of consecutive patients undergoing resection for lung cancer in our hospital was performed. The criteria for the diagnosis of ARDS was defined using the Berlin Definition. Patients with ARDS were recruited as case group and those without ARDS were served as control group. The patients in case group were compared with matched control patients in control group based on age and extent of resection,for examination of a priori defined risk factors of preoperative, intraoperative and postoperative. Results： Among the 873 patients undergoing attempted curative lung cancer resection,postoperative ARDS occurred in 43（ 4. 93%） cases. No statistically significant difference was found in the procedure of operation but there were significant differences in the extent of resection and age. After matching,there were no differences between patients in case group and those in control group with respect to sex,smoking history and tumor staging. Univariate and multivariate analysis showed that postoperative predicted lung function and perioperative infusion volumes of crystalloids were independent risk factors for the development of ARDS. Conclusion： Larger volumes of perioperative crystalloid infusion and lower postoperative predicted lung function were significant risk factors for the development of ARDS.