食管癌术后肺部并发症的危险因素分析
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摘要
目的探讨食管癌术后肺部并发症的危险因素。方法选取2014年12月到2016年12月在我院进行食管癌根治术的患者213例进行回顾性分析,统计术后患者肺部并发症的发生情况,纳入可能的相关影响因素进行分析。采用Logistics回归统计方法,分析食管癌术后肺部并发症的独立危险因素。结果 37例患者食管癌术后发生肺部并发症,占比17.37%,较为常见的并发症有肺炎、胸腔积液和呼吸衰竭;与食管癌术后肺部并发症相关的独立危险因素有年龄、美国麻醉师协会分级(ASA分级)、糖尿病史、肺结核病史、术后其他并发症、单肺通气、长期大量吸烟、FEV1(%) pred。结论食管癌术后肺部并发症的独立危险因素包括年龄、美国麻醉师协会分级(ASA分级)、糖尿病史、肺结核病史、术后其他并发症、单肺通气、长期大量吸烟、FEV1(%) pred。对患者要加强围术期护理,尤其是同时具有多个独立危险因素的患者,积极指导患者改善器官功能和肺功能,减少并发症的发生。
Objective to investigate the risk factors of pulmonary complications after esophageal carcinoma. Methods 213 patients were selected from our hospital from December 2014 to December 2016 for radical operation of esophageal carcinoma. The occurrence of pulmonary complications were analyzed retrospectively,and the related factors were analyzed. The independent risk factors of pulmonary complications after esophageal carcinoma were analyzed by using logistic multiple regression statistical method. Results 37 patients with esophageal carcinoma had pulmonary complications,accounting for 17.37% of the total. The more common complications were pneumonia,pleural effusion and respiratory failure. Independent risk factors associated with postoperative pulmonary complications of esophageal carcinoma include age,ASA classification,history of diabetes,history of tuberculosis,other postoperative complications,single lung ventilation,long-term heavy smoking,and FEV1( %) pred. Conclusion Independent risk factors for postoperative pulmonary complications after esophageal carcinoma include age,ASA classification,history of diabetes,history of tuberculosis,other postoperative complications,single lung ventilation,long-term heavy smoking,and FEV1( %) pred. Perioperative care should be strengthened for patients,especially patients with multiple independent risk factors,and patients should be actively guided to improve organ function and lung function and reduce complications.
Objective to investigate the risk factors of pulmonary complications after esophageal carcinoma. Methods 213 patients were selected from our hospital from December 2014 to December 2016 for radical operation of esophageal carcinoma. The occurrence of pulmonary complications were analyzed retrospectively,and the related factors were analyzed. The independent risk factors of pulmonary complications after esophageal carcinoma were analyzed by using logistic multiple regression statistical method. Results 37 patients with esophageal carcinoma had pulmonary complications,accounting for 17.37% of the total. The more common complications were pneumonia,pleural effusion and respiratory failure. Independent risk factors associated with postoperative pulmonary complications of esophageal carcinoma include age,ASA classification,history of diabetes,history of tuberculosis,other postoperative complications,single lung ventilation,long-term heavy smoking,and FEV1( %) pred. Conclusion Independent risk factors for postoperative pulmonary complications after esophageal carcinoma include age,ASA classification,history of diabetes,history of tuberculosis,other postoperative complications,single lung ventilation,long-term heavy smoking,and FEV1( %) pred. Perioperative care should be strengthened for patients,especially patients with multiple independent risk factors,and patients should be actively guided to improve organ function and lung function and reduce complications.
引文
1杨泽山. 431例老年食管癌患者术后肺部并发症情况及危险因素分析[J].中华全科医学,2015,13(11):1779-1781.
2 刘锦源,甄福喜,张杨杨.食管癌术后肺部并发症的危险因素分析[J].外科研究与新技术,2016,5(3):150-152.
3 吴伟,王可兵,史冬森,等.食管癌术后肺部并发症的患者相关危险因素分析[J].临床肺科杂志,2015,(7):1186-1188.
4 杨立新,梁伟,于婵娟,等.胸腹腔镜联合食管癌根治术后肺部并发症的危险因素分析[J].临床外科杂志,2017,25(7):512-515.
5 阮伟忠.食管癌患者175例术后肺部并发症的危险因素分析[J].福建医药杂志,2015,37(6):62-64.
6 茆勇,应佑国. ICU食管癌术后肺部并发症的临床调查研究[J].现代肿瘤医学,2015,23(21):3081-3083.
7 朱德奇,李汉臣,赵宝生,等.食管癌术后并发症50例临床分析[J].中外医学研究,2015,13(8):12-13.
8 田静静,李娇丽,李玮浩.全腔镜下老年食管癌根治术后肺部并发症相关因素研究[J].中华实验外科杂志,2015,32(11):2851-2853.
9 Jin Y,Xie G,Wang H,et al. Incidence and risk factors of postoperative pulmonary complications in noncardiac Chinese patients:a multicenter observational study in university hospitals[J]. Biomed Res Int,2015,2015:265165.
10 Kim ES,Kim YT,Kang CH,et al. Prevalence of and risk factors for postoperative pulmonary complications after lung cancer surgery in patients with early-stage COPD[J]. Int J Chron Obstruct Pulmon Dis,2016,11(1):1317.
11 Makiura D,Ono R,Inoue J,et al. Preoperative sarcopenia is a predictor of postoperative pulmonary complications in esophageal cancer following esophagectomy:A retrospective cohort study[J]. J Geriatr Oncol,2016,7(6):430-436.
12 Nertila K,Vjollca S,Ilir O. Risk Factors for Postoperative Pulmonary Complications after Abdominal Surgery[J]. Open Access Maced J Med Sci,2016,4(2):259-263.
13 Zhang WH,Chen XZ,Yang K,et al. Risk Factors and Survival Outcomes for Postoperative Pulmonary Complications in Gastric Cancer Patients[J]. Hepatogastroenterology,2015,62(139):766-772.
14 图尔霍·麦图松,张昌明,朱辉.食管癌切除术后围术期死亡危险因素的分析及预测模型的建立[J].世界华人消化杂志,2016(24)
15 He Y,Wu Y,Song G. Incidence and mortality rate of esophageal cancer has decreased during past 40 years in Hebei Province,China[J]. Chin J Cancer Res,2015,27(6):562-571.
16 王刚,叶永强,罗忠兵,等. 142例食管癌合并肺功能不全患者的围手术期治疗[J].现代肿瘤医学,2015,(09):1234-1236.
17 郎保平,张晓.胸腔镜腹腔镜联合手术切除食管癌29例临床探讨[J].中国实用医药,2012,17(17):109-110.
18 徐文蔚,刘宽荣.食管癌手术治疗249例预后分析[J].实用医技杂志,2017,24(1):91-92.
19 徐慧,杨梅,牛伶莉,等.食管癌围术期液体管理对肺部并发症影响的回顾性队列研究[J].中国胸心血管外科临床杂志,2017,24(5):338-345.
20 徐可,吴卫兵,王俊,等.呼吸功能锻炼对食管癌患者术后肺部并发症的影响[J].黑龙江医药科学,2016,39(6):6-8.
21 吴伟,王可兵,史冬森,等.食管癌术后肺部并发症的患者相关危险因素分析[J].临床肺科杂志,2015,20(7):1186-1188.
22 王峻峰,袁挺,邵明永,等.老年食管癌手术患者术前呼吸道准备与术后肺部并发症分析[J].实用老年医学,2015,29(3):255-256.
23 司益武,熊化生,高扬,等.食管癌患者术后并发症防治的临床观察[J].中国医学创新,2014,11(33):129-131.
24 高杨,李岩,周海英,等.食管癌患者术后肺部感染的影响因素分析[J].中华医院感染学杂志,2014,24(13):3281-3282,3285.
25 孙立章.食管癌术后肺部并发症原因分析[J].中外医疗,2014,33(2):55-56.
26 Hayami M,Watanabe M,Ishizuka N,et al. Prognostic impact of postoperative pulmonary complications following salvage esophagectomy after definitive chemoradiotherapy[J]. J Surg Oncol,2018,117(6):1251-1259.
27 Kobayashi S,Kanetaka K,Nagata Y,et al. Predictive factors for major postoperative complications related to gastric conduit reconstruction in thoracoscopic esophagectomy for esophageal cancer:a case control study[J]. BMC Surg,2018,18(1):15.
2 刘锦源,甄福喜,张杨杨.食管癌术后肺部并发症的危险因素分析[J].外科研究与新技术,2016,5(3):150-152.
3 吴伟,王可兵,史冬森,等.食管癌术后肺部并发症的患者相关危险因素分析[J].临床肺科杂志,2015,(7):1186-1188.
4 杨立新,梁伟,于婵娟,等.胸腹腔镜联合食管癌根治术后肺部并发症的危险因素分析[J].临床外科杂志,2017,25(7):512-515.
5 阮伟忠.食管癌患者175例术后肺部并发症的危险因素分析[J].福建医药杂志,2015,37(6):62-64.
6 茆勇,应佑国. ICU食管癌术后肺部并发症的临床调查研究[J].现代肿瘤医学,2015,23(21):3081-3083.
7 朱德奇,李汉臣,赵宝生,等.食管癌术后并发症50例临床分析[J].中外医学研究,2015,13(8):12-13.
8 田静静,李娇丽,李玮浩.全腔镜下老年食管癌根治术后肺部并发症相关因素研究[J].中华实验外科杂志,2015,32(11):2851-2853.
9 Jin Y,Xie G,Wang H,et al. Incidence and risk factors of postoperative pulmonary complications in noncardiac Chinese patients:a multicenter observational study in university hospitals[J]. Biomed Res Int,2015,2015:265165.
10 Kim ES,Kim YT,Kang CH,et al. Prevalence of and risk factors for postoperative pulmonary complications after lung cancer surgery in patients with early-stage COPD[J]. Int J Chron Obstruct Pulmon Dis,2016,11(1):1317.
11 Makiura D,Ono R,Inoue J,et al. Preoperative sarcopenia is a predictor of postoperative pulmonary complications in esophageal cancer following esophagectomy:A retrospective cohort study[J]. J Geriatr Oncol,2016,7(6):430-436.
12 Nertila K,Vjollca S,Ilir O. Risk Factors for Postoperative Pulmonary Complications after Abdominal Surgery[J]. Open Access Maced J Med Sci,2016,4(2):259-263.
13 Zhang WH,Chen XZ,Yang K,et al. Risk Factors and Survival Outcomes for Postoperative Pulmonary Complications in Gastric Cancer Patients[J]. Hepatogastroenterology,2015,62(139):766-772.
14 图尔霍·麦图松,张昌明,朱辉.食管癌切除术后围术期死亡危险因素的分析及预测模型的建立[J].世界华人消化杂志,2016(24)
15 He Y,Wu Y,Song G. Incidence and mortality rate of esophageal cancer has decreased during past 40 years in Hebei Province,China[J]. Chin J Cancer Res,2015,27(6):562-571.
16 王刚,叶永强,罗忠兵,等. 142例食管癌合并肺功能不全患者的围手术期治疗[J].现代肿瘤医学,2015,(09):1234-1236.
17 郎保平,张晓.胸腔镜腹腔镜联合手术切除食管癌29例临床探讨[J].中国实用医药,2012,17(17):109-110.
18 徐文蔚,刘宽荣.食管癌手术治疗249例预后分析[J].实用医技杂志,2017,24(1):91-92.
19 徐慧,杨梅,牛伶莉,等.食管癌围术期液体管理对肺部并发症影响的回顾性队列研究[J].中国胸心血管外科临床杂志,2017,24(5):338-345.
20 徐可,吴卫兵,王俊,等.呼吸功能锻炼对食管癌患者术后肺部并发症的影响[J].黑龙江医药科学,2016,39(6):6-8.
21 吴伟,王可兵,史冬森,等.食管癌术后肺部并发症的患者相关危险因素分析[J].临床肺科杂志,2015,20(7):1186-1188.
22 王峻峰,袁挺,邵明永,等.老年食管癌手术患者术前呼吸道准备与术后肺部并发症分析[J].实用老年医学,2015,29(3):255-256.
23 司益武,熊化生,高扬,等.食管癌患者术后并发症防治的临床观察[J].中国医学创新,2014,11(33):129-131.
24 高杨,李岩,周海英,等.食管癌患者术后肺部感染的影响因素分析[J].中华医院感染学杂志,2014,24(13):3281-3282,3285.
25 孙立章.食管癌术后肺部并发症原因分析[J].中外医疗,2014,33(2):55-56.
26 Hayami M,Watanabe M,Ishizuka N,et al. Prognostic impact of postoperative pulmonary complications following salvage esophagectomy after definitive chemoradiotherapy[J]. J Surg Oncol,2018,117(6):1251-1259.
27 Kobayashi S,Kanetaka K,Nagata Y,et al. Predictive factors for major postoperative complications related to gastric conduit reconstruction in thoracoscopic esophagectomy for esophageal cancer:a case control study[J]. BMC Surg,2018,18(1):15.