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作 者:王斌[1] 沈佳伟[1] 安友仲[1] Wang Bin;Shen Jia-Wei;An You-Zhong(Department of Intensive Care Unit,Peking University People's Hospital,Beijing 100044,China)
机构地区:[1]北京大学人民医院重症医学科,北京100044
出 处:《解放军医学杂志》2022年第3期264-268,共5页Medical Journal of Chinese People's Liberation Army
摘 要:目的分析肝切除术后重症患者肺不张的发生情况及其影响因素。方法回顾性分析2014年1月-2019年12月在北京大学人民医院行肝脏手术后转入ICU的患者442例。根据患者术后是否发生肺不张分为肺不张组(n=99)与非肺不张组(n=343),比较两组患者的一般资料、并发症、实验室检查、手术情况、麻醉情况、入住ICU情况及疾病预后等相关指标,应用logistic回归模型分析肝切除术后患者发生肺不张的危险因素。结果与非肺不张组比较,肺不张组院内病死率高(5.1%vs.0.5%,P=0.002),住院时间长[21(17,29)d vs.16(13,21)d,P<0.001],气管插管时间长[8.0(4.0,16.0)h vs.6.0(3.5,11.0)h,P=0.002],ICU住院时间长[2(2,5)d vs.2(2,2)d,P<0.001],低氧血症发生率高(49.5%vs.27.7%,P<0.001)。Logistic回归分析显示,手术时间[优势比(OR)=1.005,P=0.001]和围手术期低血压(OR=1.974,P=0.032)是肝切除术后重症患者发生肺不张的独立危险因素。结论肝切除术后患者肺不张发生率较高,肺不张患者病死率增高、住院时间延长。手术时间长及围手术期低血压是肝切除术后重症患者发生肺不张的独立危险因素。Objective To analyze the incidence and related factors of atelectasis in severe patients after hepatectomy.Methods A retrospective analysis was performed on 442 patients admitted to intensive care unit(ICU)after hepatectomy from 2014 to 2019 in Peking University People’s Hospital.Patients were divided into atelectasis group(n=99)and non-atelectasis group(n=343)according to the occurrence of postoperative atelectasis.General information,complications,laboratory examination,operation,anesthesia,ICU admission and disease prognosis were compared between the two groups.Logistic regression model was used to analyze the risk factors of atelectasis after hepatectomy.Results Patients in the atelectasis group had higher mortality(5.1%vs.0.5%,P=0.002),longer hospital stay[21(17,29)d vs.16(13,21)d,P<0.001],longer endotracheal intubation time[8.0(4.0,16.0)h vs.6.0(3.5,11.0)h,P=0.002],longer ICU stay[2(2,5)d vs.2(2,2)d,P<0.001]and higher occurrence rate of hypoxemia(49.5%vs.27.7%,P<0.001).Logistic regression analysis showed that longer operative time[odds ratio(OR)=1.005,P=0.001]and perioperative hypotension(OR=1.974,P=0.032)were independent risk factors for atelectasis in critically ill patients after hepatectomy.Conclusions The incidence of atelectasis is high after hepatectomy and patients with atelectasis after hepatectomy have higher rates of mortality,and longer hospital stays.Longer operative time and perioperative hypotension are independent risk factors for postoperative atelectasis.
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