腹腔镜胰十二指肠切除术患者术后肺部并发症影响因素探讨
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摘要
目的探讨腹腔镜胰十二指肠切除术(laparoscopic pancreaticoduodenectomy,LPD)患者术后肺部并发症(postoperative pulmonary complications,PPCs)的高危因素,以进一步优化LPD围术期麻醉管理,降低PPCs发生率。方法回顾性分析100例择期LPD患者的临床资料,记录患者性别、年龄、体重指数、美国麻醉医师协会分级、吸烟史、慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)、高血压、糖尿病、冠心病、肝功能分级、吸入氧浓度(fraction of inspiration O_2,FiO_2)、术中输血、术中输液量、术中保温、术中应用乌司他丁、术后镇痛、ICU留观、手术时间、术后住院时间,分析LPD患者术后发生PPCs的危险因素。结果 100例LPD患者术后发生PPCs 33例,发生率为33.0%。PPCs组吸烟率、COPD发生率、留观ICU比例及FiO_2(纯氧)使用率高于非PPCs组,乌司他丁使用率低于非PPCs组,年龄大于非PPCs组,住院时间长于非PPCs组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,有吸烟史、合并COPD、100%FiO_2为LPD患者术后发生PPCs的高危因素。结论术前有吸烟史、合并COPD、术中麻醉期间100%FiO_2为LPD患者发生PPCs的高危因素。
Objective To identify the risk factors of postoperative pulmonary complications in patients undergoing laparoscopic pancreaticoduodenectomy(LPD)and further improve perioperative anesthesia management and reduce the incidence of postoperative pulmonary complications(PPCs). Methods A retrospective survey was undertaken on 100 patients underwent LPD operation.A total of 19 items of information such as gender,age,BMI,ASA classification,smoking,chronic obstructive pulmonary disease(COPD),hypertension,diabetes,coronary heart disease,liver functional grading,fraction of inspiration O_2(FiO_2),blood transfusion,intraoperative fluid volume,intraoperative warming,application of ulinastatin during operation,postoperative analgesia,ICU observation,operation time,postoperative hospitalization time were collected,and the risk factors for PPCs were analyzed.Results Postoperative pulmonary complications occurred in 33 of the 100 patients,and the incidence was33.0%.The rate of smoking,COPD,ICU observation,pure oxygen inhalation in PPCs group was higher than that in NPPCs group,ulinastatin application was lower in PPCs group,age was older and hospitalization time was longer in PPCs group,and the difference was statistically significant(P<0.05).The multivariate logistic regression analysis displayed that smoking,COPD,pure oxygen inhalation were the risk factors of postoperative pulmonary complications in patients undergoing LPD.Conclusion The preoperative history of smoking and COPD,pure oxygen inhalation in perioperative period were high risk factors of postoperative pulmonary complications in patients undergoing LPD.
Objective To identify the risk factors of postoperative pulmonary complications in patients undergoing laparoscopic pancreaticoduodenectomy(LPD)and further improve perioperative anesthesia management and reduce the incidence of postoperative pulmonary complications(PPCs). Methods A retrospective survey was undertaken on 100 patients underwent LPD operation.A total of 19 items of information such as gender,age,BMI,ASA classification,smoking,chronic obstructive pulmonary disease(COPD),hypertension,diabetes,coronary heart disease,liver functional grading,fraction of inspiration O_2(FiO_2),blood transfusion,intraoperative fluid volume,intraoperative warming,application of ulinastatin during operation,postoperative analgesia,ICU observation,operation time,postoperative hospitalization time were collected,and the risk factors for PPCs were analyzed.Results Postoperative pulmonary complications occurred in 33 of the 100 patients,and the incidence was33.0%.The rate of smoking,COPD,ICU observation,pure oxygen inhalation in PPCs group was higher than that in NPPCs group,ulinastatin application was lower in PPCs group,age was older and hospitalization time was longer in PPCs group,and the difference was statistically significant(P<0.05).The multivariate logistic regression analysis displayed that smoking,COPD,pure oxygen inhalation were the risk factors of postoperative pulmonary complications in patients undergoing LPD.Conclusion The preoperative history of smoking and COPD,pure oxygen inhalation in perioperative period were high risk factors of postoperative pulmonary complications in patients undergoing LPD.
引文
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[15]米娜瓦·阿巴斯,祖木来提·土尔逊,杨晓红.乌司他丁对慢性阻塞性肺疾病急性期患者血清炎性因子及氧化应激的影响[J].海南医学院学报,2015,21(7):917-919.
[16]Wang LZ,Luo MY,Zhang JS,et al.Effect of ulinastatin on serum inflammatory factors in Asian patients with acute pancreatitis before and after treatment:a meta-analysis[J].Int J Clin Pharmacol Ther,2016,54(11):890-898.
[17]Li W,Qiu X,Jiang H,et al.Ulinastatin inhibits the inflammation of LPS-induced acute lung injury in mice via regulation of AMPK/NF-κB pathway[J].Int Immunopharmacol,2015,29(2):560-567.
[18]严六狮,袁慧,王伟,等.乌司他丁对腹腔镜直肠癌手术围术期炎性反应的影响[J].临床麻醉学杂志,2012,28(8):756-758.
[19]贾桂花,梁吉文,刘馨,等.乌司他丁对慢性阻塞性肺病患者腹腔镜手术中肿瘤坏死因子及白细胞介素6、8水平的影响[J].中国老年学杂志,2014,34(9):2365-2366.
[2]Subar D,Gobardhan PD,Gayet B.Laparoscopic pancreatic surgery:an overview of the literature and experience of a single cencer[J].Best Pract Res Clin Gastroenterol,2014,28(1):123-132.
[3]魏丽娟.患者吸烟情况与冠脉旁路移植术后早期结果的相关性[J].实用医学杂志,2014,30(23):3772-3774.
[4]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.
[5]Hughes MJ,McNally S,Wigmore SJ.Enhanced recovery following liver surgery:a systematic review and meta-analysis[J].HPB(Oxfod),2014,16(8):699-706.
[6]Takegahara K,Usuda J,Inoue T,et al.Preoperative management using inhalation therapy for pulmonary complications in lung cancer patients with chronic obstructive pulmonary disease[J].Gen Thorac Cardiovasc Surg,2017,65(7):388-391.
[7]金颖,李珏,王军.深吸气训练在COPD患者开胸术后的临床应用[J].局解手术学杂志,2015,24(1):45-47.
[8]Saito H,Hatakeyama K,Konno H,et al.Impact of pulmonary rehabilitation on postoperative complications in patients with lung cancer and chronic obstructive pulmonary disease[J].Thorac Cancer,2017,8(5):451-460.
[9]Zoremba M,Dette F,Hunecke T,et al.The infiuence of perioperative oxygen concentration on postopetative lung function in modetately obese adults[J].Eur J Anaesthesiol,2010,27(6):501-517.
[10]刘晓峰,强显成,赵金柱,等.肺型氧中毒的研究进展[J].解放军医学杂志,2016,41(3):258-262.
[11]李彭依,顾连兵,许仄平,等.单肺通气时降低吸入氧浓度对兔肺损伤的影响[J].中华临床医师麻醉杂志,2014,7(23):4239-4243.
[12]陈鸣,王玲,吴青华.吸入氧浓度对全麻腹腔镜直肠癌根治术患者肺泡氧合功能的影响[J].实用医药杂志,2016,33(6):522-524.
[13]王英,张岚,胡斌,等.吸入氧浓度对腹膜后腔镜手术患者血清CC16的影响[J].中国老年学杂志,2016,36(14):3503-3504.
[14]鲍方,王强,刘礼军,等.单肺通气不同水平吸入氧浓度对食管癌剖胸手术患者血清炎性因子的影响[J].中国医药,2016,11(7):1026-1030.
[15]米娜瓦·阿巴斯,祖木来提·土尔逊,杨晓红.乌司他丁对慢性阻塞性肺疾病急性期患者血清炎性因子及氧化应激的影响[J].海南医学院学报,2015,21(7):917-919.
[16]Wang LZ,Luo MY,Zhang JS,et al.Effect of ulinastatin on serum inflammatory factors in Asian patients with acute pancreatitis before and after treatment:a meta-analysis[J].Int J Clin Pharmacol Ther,2016,54(11):890-898.
[17]Li W,Qiu X,Jiang H,et al.Ulinastatin inhibits the inflammation of LPS-induced acute lung injury in mice via regulation of AMPK/NF-κB pathway[J].Int Immunopharmacol,2015,29(2):560-567.
[18]严六狮,袁慧,王伟,等.乌司他丁对腹腔镜直肠癌手术围术期炎性反应的影响[J].临床麻醉学杂志,2012,28(8):756-758.
[19]贾桂花,梁吉文,刘馨,等.乌司他丁对慢性阻塞性肺病患者腹腔镜手术中肿瘤坏死因子及白细胞介素6、8水平的影响[J].中国老年学杂志,2014,34(9):2365-2366.