胸腔镜下肺部手术患者术后发生代谢性酸中毒的相关因素分析

Analysis of related factors of metabolic acidosis after thoracoscopic pulmonary surgery

目的探讨胸腔镜下肺部手术患者术后发生代谢性酸中毒(代酸)的相关因素及机制。方法回顾分析342例行胸腔镜手术的患者。根据术后是否发生代酸进行分组,研究纳入肺叶切除手术患者共248例,其中术后酸中毒患者162例(65.32%)。肺楔形切除手术患者94例,其中术后酸中毒患者40例(42.55%)。结果酸中毒组患者手术时间、出血量、术中补液量、每公斤每小时输入液体量、术后平均住院日均高于非酸中毒组(P<0.05);不同术式下酸中毒组和非酸中毒组的术中输入的胶体种类结果差异无统计学意义(P>0.05)。结论胸腔镜下肺部手术患者术后发生代酸与手术时间、出血量及术中补液总量相关,术后发生代酸明显增加病人平均住院日和术后并发症的发生率,术后患者病人发生代酸与术中输入胶体的种类无关。

Objective To investigate the related factors and mechanisms of metabolic acidosis after thoracoscopic lung surgery.Methods A total of 342 patients who underwent thoracoscopic surgery were analyzed retrospectively.They were grouped according to whether acid substitution occurred after surgery.A total of 248 patients underwent lobotomy were included in the study,among which 162 patients(65.32%)suffered from postoperative acidosis.There were 94 patients with lung wedge resection,among which 40 patients(42.55%)had postoperative acidosis.Results The study included 248 cases of pulmonary lobectomy,of which 162(65.32%)were acidosis.There were 94 patients with cuneiform lung resection,including 40 patients with acidosis(42.55%).It was found that the operation time,intraoperative bleeding,total fluid input per kilogram per hour,average hospital day and complication rate were higher than those of non-acidosis group.There was no significant difference in the results of the type of colloid input during operation between different types of acidosis group and non-acidosis group.Conclusion Metabolic acidosis after thoracoscopic pulmonary surgery is related to the operation time,intraoperative bleeding volume and the total amount of intraoperative fluid input.Postoperative metabolic acidosis significantly increases the average hospitalization days and the incidence of postoperative complications.Postoperative metabolic acidosis is not related to the type of intraoperative colloid input.