食管癌患者术后急性肺损伤发生情况与危险因素分析

Analysis on the incidence and risk factors of postoperative acute lung injury in the patients with esophageal cancer

目的分析食管癌患者术后ALI发生状况和相关危险因素,为临床患者诊疗提供一些借鉴。方法回顾性分析2016年6月~2018年6月在本院行食管癌切术术的患者420例,将术后发生ALI的患者设为观察组,余未发生ALI的患者设为对照组。单因素分析影响患者发生ALI的相关因素,对有差异的影响因素行多因素非条件Logistic分析,同时对比两组患者转归情况,包含患者住院时间、ICU时间、死亡率和ARDS发生率。结果420例患者术后有38例出现ALI,发病率为9.05%;观察组患者平均年龄、单通时间、SIRS评分高于对照组,MVV、FEV1、HCT低于对照组,差异均有统计学意义(P<0.05);将单肺通气时间、年龄、SIRS评分、MVV、HCT及FEV1纳入至Logistic回归分析,结果显示单肺通气时间、FEV1为导致患者切除术后出现ALI的独立危险因素(P<0.05);观察组患者住院时间、ICU时间、ARDS发生率及死亡率高于对照组,差异均有统计学意义(P<0.05)。结论单肺通气时间及FEV1为导致食管癌患者切除术后出现ALI的独立危险因素,应尽可能使患者单肺通气时间减少等对肺部所造成的损害。

Objective To analyze the incidence of postoperative ALI and related risk factors in the patients with esophageal cancer,and to provide some reference for patients'diagnosis and treatment clinically.Methods A retrospective analysis was carried out on 420 patients undergoing esophageal cancer surgery in our hospital from June 2016 to June 2018.The patients who with ALI after surgery were assigned to the observation group,and the patients who did not with ALI after surgery were assigned to the control group.Related factors affecting the incidence of ALI for the patients were analyzed by univariate analysis,and multi-factor unconditional Logistic analysis was carried out for the influencing factors with differences.At the same time,the outcomes of the two groups of patients were compared,including the length of hospital stay,length of ICU stay,mortality rate,and incidence rate of ARDS.Results Among 420 patients,there were 38 cases showing ALI after surgery,with the incidence rate of 9.05%;the average age,single-pass time,and SIRS scores in the observation group were higher than those in the control group,and MVV,FEV1 and HCT were lower than those in the control group.The differences were statistically significant(P<0.05);single lung ventilation time,age,SIRS score,MVV,HCT and FEV1 were included in the Logistic regression analysis.The results showed that single lung ventilation time and FEV1 were the independent risk factors for ALI after resection surgery in the patients(P<0.05);the length of stay,length of ICU stay,ARDS incidence rate and mortality rate were higher in the observation group than those in the control group,and the differences were statistically significant(P<0.05).Conclusion Single-lung ventilation time and FEV1 are the independent risk factors for ALI after resection surgery in the patients with esophageal cancer.Single-lung ventilation time should be minimized to reduce the damages on lungs.