应用腹主动脉球囊行骶骨骨盆肿瘤手术患者发生术后肺部并发症的危险因素
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摘要
目的分析应用腹主动脉球囊行骶骨骨盆肿瘤手术患者发生术后肺部并发症的危险因素。方法选择2016年5月3日至2018年5月3日在本院应用腹主动脉球囊阻断技术行骶骨骨盆肿瘤手术的患者,收集与肺部并发症发生可能相关的危险因素,包括年龄、性别、ASA分级、体质量指数(BMI)、是否吸烟、肺部基础疾病、术前血红蛋白值、术前白蛋白值、手术时间、术中出血量、术中输血量、术中总输入量、术中入量-出量、腹主动脉球囊阻断的时间及次数,并收集患者术后肺部并发症发生情况,进行统计学分析。结果纳入统计的341例患者中,63例(18.5%)发生术后肺部并发症。多因素逻辑回归分析表明,年龄(≥60岁)、ASA分级(Ⅲ级)、球囊阻断总时间(> 120 min)是应用腹主动脉球囊行骶骨骨盆肿瘤手术患者术后发生肺部并发症的独立危险因素。结论年龄≥60岁、ASA分级Ⅲ级、术中腹主动脉球囊阻断总时间超过120 min的患者术后发生肺部并发症的风险高,应采取相应的护理及治疗措施以降低其术后发生肺部并发症的风险。
Objective To analyze risk factors for post-operative pulmonary complications after surgical excision of pelvic and sacrum tumors assisted by abdominal aortic balloon occlusion. Methods Retrospectively analyzed peri-operative factors of 341 patients who had undergone surgical excision of pelvic and sacrum tumors assisted by abdominal aortic balloon occlusion in our hospital from May 3 rd,2016 to May 3 rd,2018. A logistic regression analysis was performed on factors which included:age,sex,ASA classification,BMI,smoking,preoperative pulmonary comorbidities,pre-operative hemoglobin content,pre-operative albumin content,surgery time,blood loss,the amount of blood transfusion,total infusion amount,amount of fluid input-output,occlusion time and times of aortic balloon and post-operative pulmonary complications. Results 63 of 341 patients(18.5%)developed post-operative pulmonary complications. Multiple regression analysis showed that age(≥ 60 years),ASA classification(ASA Ⅲ),total occlusion time of aortic balloon(> 120 min)were the independent risk factors of post-operative pulmonary complications after surgical excision of pelvic and sacrum tumors assisted by abdominal aortic balloon occlusion. Conclusions Patients over 60 whose ASA Ⅲ and total occlusion time of aortic balloon were longer than 120 minutes were at higher risk of developing post-operative pulmonary complications after surgical excision of pelvic and sacrum tumors assisted by abdominal aortic balloon occlusion. Necessary nursing and treatment measures should be taken to decrease their risk.
Objective To analyze risk factors for post-operative pulmonary complications after surgical excision of pelvic and sacrum tumors assisted by abdominal aortic balloon occlusion. Methods Retrospectively analyzed peri-operative factors of 341 patients who had undergone surgical excision of pelvic and sacrum tumors assisted by abdominal aortic balloon occlusion in our hospital from May 3 rd,2016 to May 3 rd,2018. A logistic regression analysis was performed on factors which included:age,sex,ASA classification,BMI,smoking,preoperative pulmonary comorbidities,pre-operative hemoglobin content,pre-operative albumin content,surgery time,blood loss,the amount of blood transfusion,total infusion amount,amount of fluid input-output,occlusion time and times of aortic balloon and post-operative pulmonary complications. Results 63 of 341 patients(18.5%)developed post-operative pulmonary complications. Multiple regression analysis showed that age(≥ 60 years),ASA classification(ASA Ⅲ),total occlusion time of aortic balloon(> 120 min)were the independent risk factors of post-operative pulmonary complications after surgical excision of pelvic and sacrum tumors assisted by abdominal aortic balloon occlusion. Conclusions Patients over 60 whose ASA Ⅲ and total occlusion time of aortic balloon were longer than 120 minutes were at higher risk of developing post-operative pulmonary complications after surgical excision of pelvic and sacrum tumors assisted by abdominal aortic balloon occlusion. Necessary nursing and treatment measures should be taken to decrease their risk.
引文
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[12] MATSUMURA Y,MATSUMOTO J,KONDO H,et al. Partial occlusion,conversion from thoracotomy,undelayed but shorter occlusion:resuscitative endovascular balloon occlusion of the aorta strategy in Japan[J]. Eur J Emerg Med,2018,25(5):348-354.
[13]周桥灵,赵伟成,廖美娟,等.不同剂量右美托咪定联合乌司他丁对肺叶切除术患者肺损伤的保护作用[J].实用医学杂志,2018,34(2):281-284.
[14] PERLIKOS F,LAGIOU M,PAPALOIS A,et al. Lazaroid(U-74389G)ameliorates lung injury due to lipid peroxidation and nitric oxide synthase-dependent reactive oxygen species generation caused by remote systematic ischemia-reperfusion following thoracoabdominal aortic occlusion[J]. Int J Surg,2018,55:156-161.
[15] YANG L,CHONG-QI T,HAI-BO S,et al. Appling the abdominalaortic-balloon occluding combine with blood pressure sensor of dorsal artery of foot to control bleeding during the pelvic and sacrum tumors surgery[J]. J Surg Oncol,2008,97(7):626-628.
[16] ZHANG L,GONG Q,XIAO H,et al. Control of blood loss during sacral surgery by aortic balloon occlusion[J]. Anesth&Analg,2007,105(3):700–703.
[17]MI C,LU H,LIU H. Surgical excision of sacral tumors assisted by occluding the abdominal aorta with a balloon dilation catheter:A report of 3 cases[J]. Spine(Phila Pa 1976),2005,30(20):E614-E616.
[2] LUO Y,DUAN H,LIU W,et al. Clinical evaluation for lower abdominal aorta balloon occluding in the pelvic and sacral tumor resection[J]. J Surg Oncol,2013,108(3):148-151.
[3] ZHANG Y1,GUO W,TANG X,et al. Can aortic balloon occlusion reduce blood loss during resection of sacral tumors that extend into the lower lumber spine?[J]. Clin Orthop Relat Res,2018,476(3):490-498.
[4] SERPA NETO A,HEMMES S N,BARBAS C S,et al. Incidence of mortality and morbidity related to postoperative lung injury in patients who have undergone abdominal or thoracic surgery:a systematic review and metaanalysis[J]. Lancet Respir Med,2014,2(12):1007-1015.
[5] KIRMEIER E,ERIKSSON LI,LEWALD H,et al. Post-anaesthesia pulmonary complications after use of muscle relaxants(POPULAR):a multicentre,prospective observational study[J]. Lancet Respir Med,2019,7(2):129-140.
[6] NETO A S,DA COSTA L G V,HEMMES S N T,et al. The LAS VEGAS risk score for prediction of postoperative pulmonary complications:An observational study[J]. Eur J Anaesthesiol,2018,35(9):691-701.
[7]林华赋,程芳,黄敏,等.老年患者腹腔镜手术后早期肺部并发症的影响因素[J].实用医学杂志,2018,34(13):2213-2216.
[8] KATSENI K,CHALKIAS A,KOTSIS T,et al. The effect of perioperative ischemia and reperfusion on multiorgan dysfunction following abdominal aortic aneurysm repair[J]. Biomed Res Int,2015,71(6):1869-1872.
[9] CHAO C S,TSAI C S,WANG Y H,et al. Porcine model for observing changes due to ischemia/reperfusion injury secondary to intra-abdominal endovascular balloon occlusion[J]. Exp Biol Med(Maywood),2016,241(16):1834-1843.
[10] MORRISON J J,ROSS J D,MARKOV N P,et al. The inflammatory sequelae of aortic balloon occlusion in hemorrhagic shock[J]. J Surg Res,2014,191(2):423-431.
[11] KUCKELMAN J,BARRON M,MOE D,et al. Extending the golden hour for Zone 1 Reboa:improved survival and reperfusion injury with intermittent versus continuous Reboa in a porcine severe truncal hemorrhage model[J]. J Trauma Acute Care Surg,2018,85(2):318-326.
[12] MATSUMURA Y,MATSUMOTO J,KONDO H,et al. Partial occlusion,conversion from thoracotomy,undelayed but shorter occlusion:resuscitative endovascular balloon occlusion of the aorta strategy in Japan[J]. Eur J Emerg Med,2018,25(5):348-354.
[13]周桥灵,赵伟成,廖美娟,等.不同剂量右美托咪定联合乌司他丁对肺叶切除术患者肺损伤的保护作用[J].实用医学杂志,2018,34(2):281-284.
[14] PERLIKOS F,LAGIOU M,PAPALOIS A,et al. Lazaroid(U-74389G)ameliorates lung injury due to lipid peroxidation and nitric oxide synthase-dependent reactive oxygen species generation caused by remote systematic ischemia-reperfusion following thoracoabdominal aortic occlusion[J]. Int J Surg,2018,55:156-161.
[15] YANG L,CHONG-QI T,HAI-BO S,et al. Appling the abdominalaortic-balloon occluding combine with blood pressure sensor of dorsal artery of foot to control bleeding during the pelvic and sacrum tumors surgery[J]. J Surg Oncol,2008,97(7):626-628.
[16] ZHANG L,GONG Q,XIAO H,et al. Control of blood loss during sacral surgery by aortic balloon occlusion[J]. Anesth&Analg,2007,105(3):700–703.
[17]MI C,LU H,LIU H. Surgical excision of sacral tumors assisted by occluding the abdominal aorta with a balloon dilation catheter:A report of 3 cases[J]. Spine(Phila Pa 1976),2005,30(20):E614-E616.