胸外科术后并发急性肺损伤/急性呼吸窘迫综合征及影响其死亡的危险因素分析  

Analysis of risk factors for death of patients with acute lung injury/acute respiratory distress syndrome after thoracic surgery

作　　者：刘东东 王海涛 沈剑[2] 付绍梓[2] 孙高忠 黄思远[2] 徐鹤云[2] Liu Dongdong;Wang Haitao;Shen Jian;Fu Shaozi;Sun Gaozhong;Huang Siyuan;Xu Heyun(Graduate School of Bengbu Medical College,Bengbu 233000,C hina;Department of Cardiothoracic Surgery,Zhejiang Provincial People's Hospital/People's Hospital of Hang zhou Medical College,Hangzhou 310014,China)

机构地区：[1]蚌埠医学院研究生院,安徽蚌埠233000 [2]浙江省人民医院/杭州医学院附属人民医院心胸外科,浙江杭州310014

出　　处：《实用肿瘤杂志》2020年第5期440-445,共6页Journal of Practical Oncology

基　　金：浙江省中医药管理局项目(2019ZA002);浙江省医药卫生平台研究计划面上项目(2020KY009);浙江省自然科学基金项目(LY20H010005)。

摘　　要：目的研究胸外科术后并发急性肺损伤(acute lung injury,ALI)/急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)及影响其死亡的危险因素。方法收集接受普胸手术(食管癌及肺癌手术)后发生ALI/ARDS的病例(观察组20例),与随机抽取的等量的普胸手术后未发生ALI/ARDS的病例(对照组20例)的术前、术中和术后临床资料进行比较,并比较胸外科术后发生ALI/ARDS的病例中死亡病例与生存患者的临床资料。结果观察组与对照组在手术原因、年龄、入院时白蛋白水平、单肺通气时间、美国麻醉医师协会(American Society of Anesthesiologists,ASA)评分、失血量、补液量、术后C反应蛋白(C-reactive protein,CRP)水平和术后白蛋白水平方面比较,差异均具有统计学意义(均P<0.05)。观察组中术后发生ALI/ARDS并死亡的患者与生存患者比较,在手术原因和术后白蛋白水平方面比较,差异均具有统计学意义(均P<0.05)。结论年龄、入院时白蛋白水平、单肺通气时间、ASA评分、失血量、补液量、术后CRP水平和术后白蛋白水平是普胸手术后是否并发ALI/ARDS的影响因素。手术原因和术后白蛋白水平也是普胸外科术后并发ALI/ARDS死亡的影响因素。Objective To study the acute lung injury(ALI)/acute respiratory distress syndrome(ARDS)and its risk factors for death after thoracic surgery.Methods Twenty ALI/ARDS cases after thoracic surgery for lung cancer or esophageal cancer(observation group)and 20 random patients after thoracic surgery without postoperative ALI/ARDS(control group)were collected.The preoperative,intraoperative and postoperative clinical data of the two groups were compared,and the clinical data of patients who died of ALI/ARDS after thoracic surgery and those who survived were compared.Results There were statistically significant differences between the observation group and control group in terms of surgical reason,age,albumin level at admission,duration of single lung ventilation,American Society of Anesthesiologists(ASA)score,blood loss,rehydration,postoperative C-reactive protein(CRP)level,and postoperative albumin level(all P<0.05).In the observation group,there were statistically significant differences in surgical reason and postoperative albumin level between patients who died of ALI/ARDS and those survived(both P<0.05).Conclusions Age,albumin level at admission,duration of single lung ventilation,ASA score,blood loss,rehydration,postoperative CRP level and postoperative albumin level are the risk factors for complication of ALI/ARDS after thoracic surgery.Meanwhile,the surgical reason and postoperative albumin level are the risk factors of the death with ALI/ARDS after thoracic surgery.

关 键 词：肺癌 食管癌 急性肺损伤 急性呼吸窘迫综合征 危险因素 手术 

分 类 号：R734.2[医药卫生—肿瘤]