摘要
目的 探究行择期结直肠手术的老年患者术后肺部并发症(PPC)的围术期相关危险因素,为更好地预防和控制老年患者发生PPC提供参考。方法 将2014年10月至2017年3月在中国医科大学附属盛京医院行择期结直肠手术且年龄≥65岁的患者445例,按有无PPC分成2组,回顾性分析围术期PPC的相关危险因素。PPC包括术后肺炎、肺不张、胸膜渗出、肺栓塞、呼吸衰竭、气胸、急性呼吸窘迫综合征。结果 在研究纳入的445例患者中,PPC组49例(11%),非PPC组396例(89%)。老年患者行择期结直肠手术PPC的较高危险因素主要是高龄(年龄≥75岁)、ASA>Ⅱ级、高血压、心肌缺血、肺部基础疾病、开腹、术中输血、术前血红蛋白<100 g/L、术前白蛋白<35 g/L。其他因素如性别、糖尿病、抽烟、饮酒、术后静脉镇痛泵的使用、术后拮抗剂(新斯的明)等,2组间无统计学差异。开腹、ASA>Ⅱ级是PPC发生率升高的独立危险因素。结论 老年患者行择期结直肠手术前,加强对年龄、ASA分级、心肺合并症等因素的评估,尽量选择腹腔镜手术,纠正贫血及营养状态是减少PPC的有效措施。
Objective To investigate the perioperative risk factors associated with postoperative pulmonary complications(PPC)in elderly patients undergoing elective colorectal surgery.Methods We retrospectively analyzed 445 patients aged≥65 years undergoing elective colorectal surgery at Shengjing Hospital of China Medical University between October 2014 and March 2017.Patients were divided into 2 groups based on the occurrence of PPC,and the perioperative risk factors associated with PPC were analyzed.PPC includes postoperative pneumonia,atelectasis,pleural effusion,pulmonary embolism,respiratory failure,pneumothorax,and acute respiratory distress syndrome.Results Among the 445 patients enrolled in the study,49(11%)belonged to the PPC group and 396(89%)to the non-PPC group.Elderly patients undergoing elective colorectal surgery showed a higher risk of PPC.The risk factors primarily included advanced age(≥75 years),American Society of Anesthesiologists(ASA)class>Ⅱ,hypertension,myocardial ischemia,basic lung diseases,laparotomy,intraoperative blood transfusion,preoperative hemoglobinlevel<100 g/L,and preoperative serum albumin level<35 g/L.No statistically significant intergroup differences were observed in terms of gender,diabetes,smoking,alcohol consumption,postoperative intravenous analgesic pump and antagonist(neostigmine)use.Laparotomy and ASA class>Ⅱwere independent risk factors for an increased incidence of PPC.Conclusion Attempting to minimize the incidence of PPC through effective preoperative measures is important in elderly patients undergoing elective colorectal surgery.These measures include the accurate assessment of age,ASA class,cardiopulmonary complications,and other factors,as well as the correction of anemia and nutritional status.Attempts should be made to perform laparoscopic surgery in these patients.
作者
桑阿明
柴军
谭媚月
陶倩云
陈丽娜
SANG Aming;CHAI Jun;TAN Meiyue;TAO Qianyun;CHEN Lina(Department of Anesthesiology,Shengjing Hospital,China Medical University,Shenyang 110004,China)
出处
《中国医科大学学报》
CAS
CSCD
北大核心
2018年第5期426-430,共5页
Journal of China Medical University
基金
辽宁省自然科学基金(2013021071)
关键词
老年
麻醉
肺部并发症
结直肠手术
old age
anesthesia
pulmonary complications
colorectal surgery
作者简介
桑阿明(1988-),男,硕士研究生.;通信作者:柴军,E-mail:chaij@sj-hospital.org
