肺癌左全肺切除术后心肺并发症危险因素分析

Risk Factor Analysis of Cardiopulmonary Complications after Left Total Pneumonectomy for Lung Cancer

目的分析肺癌左全肺切除术后患者围术期发生心肺并发症(PCC)的危险因素,为临床干预提供参考。方法收集2012年1月至2015年1月我院收治住院的80例肺癌行左全肺切除术患者资料,根据患者术后是否发生PCC将患者分为PCC组和无心肺并发症(NPCC)组,比较两组患者基本资料、临床特点、手术情况等,采用Logisitc回归分析探讨患者发生PCC的可能影响因素。结果 PCC组患者共29例,NPCC组共51例,PCC发生率为36.25%。两组患者比较,年龄、吸烟史、合并冠心病、合并高血压、合并COPD、术中出血量、手术时间、术前肺功能相比较,差异有统计学意义(P<0.05)。年龄越大[OR=1.84,95%CI(1.213,4.049)]、术中出血量越高[OR=3.77,95%CI(1.64,6.81)]、手术时间越长[OR=5.61,95%CI(2.82,10.45)]、有吸烟史[OR=4.47,95%CI(2.82,10.45)]的患者更易发生PCC,术前FEV1%≥80%[OR=0.34,95%CI(0.21,0.67)]及MVV%≥80%[OR=0.23,95%CI(0.17,0.89)]是PCC发生的保护因素。结论对年龄较大、术中出血量高、手术时间越长、有吸烟史、术前肺功能不佳的肺癌患者,应谨慎评估手术指征,采取针对性措施降低PCC发生率。

Objective To analyze the risk factors of perioperative cardiopulmonary complications（PCC） in patients under- going left total pneumonectomy for lung cancer and to provide reference for clinical intervention. Methods Clinical data of 80 cases of lung cancer undergoing left total pneumonectomy from January 2012 to January 2015 in our hospital were collected. Patients were divided into PCC group and non-PCC （NPCC） group according to whether they occurred PCC after operation. The basic materials, clinical features, operation results and other data were compared. Logistic regression analysis was adopted to study possible influencing factors of PCC morbidity. Results There were 19 cases in PCC group and 51 cases in NPCC group, with an incidence rate of 36. 25 %. Comparing the two groups, the differences of age, smoking history, coronary heart disease, hypertension, COPD, intraoperative blood loss, operation time and preoperative lung function were statistically significant （ P 〈 0. 05 ）. Patients with larger age [ OR = 1.84,95% CI（ 1. 213,4. 049） ~ ,more intraoperative blood loss [ OR = 3.77,95% CI（ 1.64,6. 81 ） ], longer operation time [ OR = 5.61,95% CI （ 2. 82, 10. 45 ） ], smoking history [ OR = 4.47,95% CI （ 2. 82, 10. 45 ） 1 were more prone to PCC. Preoperative FEV~% 1〉 80% [ OR = O. 34,95% CI（0. 21,0. 67）and MVV% t〉 80% [ OR = 0. 23,95% CI （0. 17,0. 89） ] were protective fac- tors for the occurrence of PCC. Conclusion As for patients with lung cancer who are older, have a higher amount of blood loss during operation, longer operation time, smoking history and lower preoperative lung function, we should carefully evaluate the indications of surgery and take pertinence measures to reduce the incidence of PCC.