回顾性分析食管癌术后发生急性呼吸衰竭的危险因素

Retrospective Analysis of Risk Factors of Acute Respiratory Failure After Esophageal Cancer Surgery

目的分析食管癌术后发生急性呼吸衰竭的危险因素。方法选取2022年1—12月于福建省肿瘤医院经相关检查确诊为食管癌的178例患者进行回顾性研究,均实施食管癌三野根治术治疗,统计术后急性呼吸衰竭发生率,分析食管癌术后发生急性呼吸衰竭的危险因素。结果178例食管癌患者食管癌三野根治术后17例(9.55%)发生急性呼吸衰竭,161例(90.45%)未发生急性呼吸衰竭。单因素分析结果显示,发生组与未发生组年龄、吸烟史、TNM分期、合并糖尿病、手术方式、术后二次开胸、合并肺部感染、血浆白蛋白、疼痛情况比较,差异有统计学意义(P<0.05)。多因素logistic分析结果显示年龄≥70岁(OR=1.414,P=0.044)、存在吸烟史(OR=1.441,P=0.026)、TNM分期Ⅱ~Ⅲ期(OR=1.645,P<0.001)、合并糖尿病(OR=1.671,P<0.001)、术后二次开胸(OR=1.384,P=0.021)、合并肺部感染(OR=1.841,P<0.001)、血浆白蛋白>25 g/L(OR=1.376,P=0.005)、中重度疼痛(OR=1.541,P<0.001)为食管癌术后发生急性呼吸衰竭的危险因素(P<0.05)。结论食管癌术后发生急性呼吸衰竭的发生率较高,为改善其预后效果需要在围术期加强对可控因素的管理,尽可能减少对治疗及预后效果的影响。

Objective To analyze the risk factors of acute respiratory failure after esophageal cancer surgery.Methods From January to December 2022,178 patients who were diagnosed as esophageal cancer by relevant examinations in the Fujian Cancer Hospital were retrospectively studied.All patients were treated with three-field radical resection of esophageal cancer,the incidence of postoperative acute respiratory failure was counted,the risk factors of acute respiratory failure after esophageal cancer surgery were analyzed.Results Among 178 patients with esophageal cancer,17 cases(9.55%)developed acute respiratory failure after three-field radical resection of esophageal cancer,and 161 cases(90.45%)did not develop acute respiratory failure.Univariate analysis showed that there were significant differences in age,smoking history,TNM stage,diabetes mellitus,surgical method,postoperative secondary thoracotomy,pulmonary infection,plasma albumin and pain between the two groups(P<0.05).Multivariate logistic analysis showed age≥70 years old(OR=1.414,P=0.044),history of smoking(OR=1.441,P=0.026),TNM stage Ⅱ-Ⅲ(OR=1.645,P<0.001),combined with diabetes(OR=1.671,P<0.001),secondary thoracotomy(OR=1.384,P=0.021),pulmonary infection(OR=1.841,P<0.001),plasma albumin>25 g/L(OR=1.376,P=0.005),moderate to severe pain(OR=1.541,P<0.001)were risk factors for acute respiratory failure after esophageal cancer surgery(P<0.05).Conclusion The incidence of acute respiratory failure after esophageal cancer surgery is high.In order to improve its prognosis,it is necessary to strengthen the management of controllable factors in the perioperative period,and minimize the impact on treatment and prognosis effect.