中国癌症防治杂志
中國癌癥防治雜誌
중국암증방치잡지
CHINESE JOURNAL OF ONCOLOGY PREVENTION AND TREATMENT
2014年
2期
163-166
,共4页
贺盛%潘灵辉%林飞%葛万运%戴惠军%李玮
賀盛%潘靈輝%林飛%葛萬運%戴惠軍%李瑋
하성%반령휘%림비%갈만운%대혜군%리위
肺肿瘤%肺叶切除术%拔管延迟%危险因素
肺腫瘤%肺葉切除術%拔管延遲%危險因素
폐종류%폐협절제술%발관연지%위험인소
Lung neoplasm%Lobectomy%Delayed extubation%Risk factor
目的:探讨影响肺癌患者行肺叶切除术后拔管延迟的因素。方法采用回顾性调查方法,收集广西医科大学附属肿瘤医院2008年10月至2013年10月706例在全麻下实施肺癌肺叶切除的患者的临床资料,记录患者一般情况、术前检查、术中和术后管理等相关因素,采用非条件Logistic逐步回归模型方法分析,筛选导致患者术后拔管延迟的相关因素。将706例分为正常拔管组655例和拔管延迟组51例。分析两组患者术后并发症的发生率和住院时间,以及拔管延迟与术后并发症、住院时间的关系。结果全组患者术后拔管延迟发生率为7.2%(51/706)。拔管延迟组和正常拔管组患者术后并发症的发生率分别为35.3%(18/51)和15.6%(102/655),拔管延迟组患者术后并发症的发生率明显高于正常拔管组,差异有统计学意义(P<0.05)。拔管延迟组和正常拔管组患者的平均住院时间分别为(17.5±6.2)d和(14.1±7.3)d,拔管延迟组患者的住院时间明显长于正常拔管组,差异有统计学意义(P<0.05)。经非条件Logistic逐步回归模型分析显示影响患者术后拔管延迟有5个独立危险因素:男性(OR=1.511,P=0.046);年龄跃60岁(OR=6.568,P<0.001);单肺通气时间过长(OR=1.268, P=0.047);尿量约17 ml/h(OR=1.456,P=0.032);术前肺功能异常(OR=1.579,P=0.033)。结论肺癌患者行肺叶切除术术后拔管延迟将增加术后住院时间和并发症的发生。术后发生拔管延迟主要与患者术前肺功能较差、老年、男性患者、尿量及单肺通气时间长等多种因素的协同作用相关。
目的:探討影響肺癌患者行肺葉切除術後拔管延遲的因素。方法採用迴顧性調查方法,收集廣西醫科大學附屬腫瘤醫院2008年10月至2013年10月706例在全痳下實施肺癌肺葉切除的患者的臨床資料,記錄患者一般情況、術前檢查、術中和術後管理等相關因素,採用非條件Logistic逐步迴歸模型方法分析,篩選導緻患者術後拔管延遲的相關因素。將706例分為正常拔管組655例和拔管延遲組51例。分析兩組患者術後併髮癥的髮生率和住院時間,以及拔管延遲與術後併髮癥、住院時間的關繫。結果全組患者術後拔管延遲髮生率為7.2%(51/706)。拔管延遲組和正常拔管組患者術後併髮癥的髮生率分彆為35.3%(18/51)和15.6%(102/655),拔管延遲組患者術後併髮癥的髮生率明顯高于正常拔管組,差異有統計學意義(P<0.05)。拔管延遲組和正常拔管組患者的平均住院時間分彆為(17.5±6.2)d和(14.1±7.3)d,拔管延遲組患者的住院時間明顯長于正常拔管組,差異有統計學意義(P<0.05)。經非條件Logistic逐步迴歸模型分析顯示影響患者術後拔管延遲有5箇獨立危險因素:男性(OR=1.511,P=0.046);年齡躍60歲(OR=6.568,P<0.001);單肺通氣時間過長(OR=1.268, P=0.047);尿量約17 ml/h(OR=1.456,P=0.032);術前肺功能異常(OR=1.579,P=0.033)。結論肺癌患者行肺葉切除術術後拔管延遲將增加術後住院時間和併髮癥的髮生。術後髮生拔管延遲主要與患者術前肺功能較差、老年、男性患者、尿量及單肺通氣時間長等多種因素的協同作用相關。
목적:탐토영향폐암환자행폐협절제술후발관연지적인소。방법채용회고성조사방법,수집엄서의과대학부속종류의원2008년10월지2013년10월706례재전마하실시폐암폐협절제적환자적림상자료,기록환자일반정황、술전검사、술중화술후관리등상관인소,채용비조건Logistic축보회귀모형방법분석,사선도치환자술후발관연지적상관인소。장706례분위정상발관조655례화발관연지조51례。분석량조환자술후병발증적발생솔화주원시간,이급발관연지여술후병발증、주원시간적관계。결과전조환자술후발관연지발생솔위7.2%(51/706)。발관연지조화정상발관조환자술후병발증적발생솔분별위35.3%(18/51)화15.6%(102/655),발관연지조환자술후병발증적발생솔명현고우정상발관조,차이유통계학의의(P<0.05)。발관연지조화정상발관조환자적평균주원시간분별위(17.5±6.2)d화(14.1±7.3)d,발관연지조환자적주원시간명현장우정상발관조,차이유통계학의의(P<0.05)。경비조건Logistic축보회귀모형분석현시영향환자술후발관연지유5개독립위험인소:남성(OR=1.511,P=0.046);년령약60세(OR=6.568,P<0.001);단폐통기시간과장(OR=1.268, P=0.047);뇨량약17 ml/h(OR=1.456,P=0.032);술전폐공능이상(OR=1.579,P=0.033)。결론폐암환자행폐협절제술술후발관연지장증가술후주원시간화병발증적발생。술후발생발관연지주요여환자술전폐공능교차、노년、남성환자、뇨량급단폐통기시간장등다충인소적협동작용상관。
Objective To determine independent predictors of delayed postoperative extubation in patients undergoing lung cancer surgery. Method Records were retrospectively reviewed for 706 lung cancer patients who underwent lung resection under general anesthesia at the Affiliated Tumor Hospital of Guangxi Medical University from October 2008 to October 2013.Data were extracted on general patient condition,preoperative examination results,intra-and postoperative management,and other relevant factors.Uncon-ditional logistic regression was used to identify whether any of these indicators predicted delayed postoperative extubation.Then we compared incidence of postoperative complications and hospitalization time in the patients who underwent delayed extubation (n=51) and those who did not(n=655). Result The incidence of delayed extubation in 706 lung cancer patients was 7.2%.Postoperative complications occurred in 18 of 51 patients in the delayed extubation group (35.3%),while they occurred in only 102 of 655 patients in the normal extubation group (15.6%,P<0.05).Length of hospitalization was significantly longer in the delayed extubation group (17.5±6.2 days)than in the normal extubation group(14.1±7.3 days,P<0.05).Unconditional logistic regression identified five of the 25 variables tested as independent risk factors for delayed extubation:age>60 years (OR=6.568,P<0.001),prolonged single-lung ventilation(OR=1.268,P=0.047),male gender(OR=1.511,P=0.046),urinary flow<17 ml/h(OR=1.456,P=0.032),and reduced lung function(OR=1.579,P=0.033). Conclusions Delayed postoperative extubation after lobectomy in lung cancer patients is associated with longer hospital stay and greater risk of postoperative complications. This delay is caused by multi-factor synergism,related mainly to poor preoperative lung function,older age,male gender,poor urinary function,prolonged single-lung ventilation and other relevant factors.