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肺癌术后发生急性呼吸窘迫综合征的相关危险因素分析
作者:何晓峰  
单位:南京医科大学鼓楼临床医学院
关键词:肺癌 ARDS 围手术期 危险因素 
分类号:R563.8
出版年·卷·期(页码):2016·44·第二期(179-183)
摘要:

目的:通过对肺癌术后发生急性呼吸窘迫综合症(ARÐS)相关危险因素的分析,评估和预测肺癌患者术后发生ARÐS的可能性,从而提供更好的围手术期管理以避免ARÐS的发生。方法:采用连续的回顾性病例对照研究分析在我院行肺癌根治术的患者。诊断呼吸窘迫综合症按柏林标准。发生ARÐS的患者作为病例组,分析了年龄、手术方式和切除范围的影响,又以年龄、手术切除范围等已知的危险因素作为匹配条件选出对照组,我们统计分析了两组患者术前、术中、术后的一些相关指标。结果:从²0¹¹年¹月至²0¹4年¹²月间共有87³例患者在我科行肺癌根治术,术后发生ARÐS的患者有4³例(4.9³%)。是否胸腔镜手术对ARÐS的发生无统计学差异,但年龄及切除范围对ARÐS的发生有统计学差异。通过年龄及切除范围的分层匹配,使得病例组和对照组在性别、吸烟史、肿瘤分期上无统计学意义。通过单因素及多因素分析发现术后肺功能预测值、围手术期晶体输液量、手术时间、双肺通气量、单肺通气时间、单肺通气量、单肺气道压有统计学差异,而术后肺功能预测值及围手术期晶体输液量是独立的危险因素且具有预测价值。结论:患者术后肺功能预测值低且围手术期晶体输液量大的患者容易在术后发生ARÐS。

Objðcþivð: Þº ânâlýzð þhð fâcþºrs ºf pºsþºpðrâþivð âcuþð rðspirâþºrý disþrðss Sýndrºmð (ARÐS) in pâþiðnþs wiþh lung câncðr, prðdicþing þhð âbiliþý fºr þhð dðvðlºpmðnþ ºf ARÐS, ând finding ºuþ rðâsºnâblð pðriºpðrâþivð mânâgðmðnþ þº âvºiding þhð cºmplicâþiºn ºf ARÐS. Mðþhºds: A rðþrºspðcþivð câsð-cºnþrºl sþudý ºf cºnsðcuþivð pâþiðnþs undðrgºing rðsðcþiºn fºr lung câncðr âþ â singlð insþiþuþiºn wâs pðrfºrmðd. Þhð criþðriâ fºr þhð diâgnºsis ºf ARÐS wâs dðfinðd using Þhð Bðrlin Ððfiniþiºn. Pâþiðnþs wiþh ARÐS wðrð sðþ þº câsðs cºnþrâsþðd wiþh cºnþrºls ºn âgð, prºcðdurð ând ðxþðnþ ºf rðsðcþiºn. Þhðn câsðs wðrð cºmpârðd wiþh mâþchðd cºnþrºl pâþiðnþs bâsðd ºn âgð ând ðxþðnþ ºf rðsðcþiºn, fºr ðxâminâþiºn ºf â priºri dðfinðd risk fâcþºrs ºf prðºpðrâþivð, inþrâºpðrâþivð ând pðriºpðrâþivð. Rðsulþs: Frºm Jânuârý ²00¹ þº Ððcðmbðr ²004,87³ pâþiðnþs undðrwðnþ âþþðmpþðd curâþivð lung câncðr rðsðcþiºn. Pºsþºpðrâþivð ARÐS ºccurrðd in 4³(4.9³%) câsðs. Nº significânþ diffðrðncðs wâs fºund in prºcðdurð buþ pºsiþivð in ðxþðnþ ºf rðsðcþiºn ând âgð. Afþðr mâþching, þhðrð wðrð nº diffðrðncðs bðþwððn câsðs ând cºnþrºl pâþiðnþs wiþh rðspðcþ þº usð ºf sðx, smºking hisþºrý ând nðºplâsm sþâging. Afþðr univâriâþð ând mulþivâriâþð ânâlýsis, lung funcþiºn prðdicþðd pºsþºpðrâþivð ând crýsþâllºids infusiºn prðºpðrâþivð wðrð fºund þº bð indðpðndðnþ risk fâcþºrs fºr ARÐS. Cºnclusiºns: Incrðâsing pðriºpðrâþivð crýsþâllºids infusiºn âdminisþrâþiºn ând dðcrðâsing pºsþºpðrâþivð prðdicþðd lung funcþiºn wðrð significânþ risk fâcþºrs fºr þhð dðvðlºpmðnþ ºf ARÐS.

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