术中液体输注量对微创腔镜食管切除术后肺部并发症的影响  

Influence of intraoperative fluid volume on pulmonary complications in patients undergoing minimally invasive endoscopic esophagectomy

作　　者：陈颖[1,2] 尚凯茜[3] 田伟 孙琪荣 余海 CHEN Ying;SHANG Kaixi;TIAN Wei;SUN Qirong;YU Hai(Department of Anesthesiology,West China Hospital,Sichuan University,Chengdu,610041,P.R.China;Department of Anesthesiology,Liangshan Prefecture Hospital of Integrated Traditional Chinese and Western Medicine,Xichang,615000,Sichuan,P.R.China;Department of Anesthesiology,Chengdu Office Hospital of the People's Government of Tibet Autonomous Region,Chengdu,610041,P.R.China;Department of Anesthesiology,Neijiang People's Hospital,Neijiang,641400,Sichuan,P.R.China)

机构地区：[1]四川大学华西医院麻醉科,成都610041 [2]凉山州中西医结合医院麻醉科,四川西昌615000 [3]西藏自治区人民政府驻成都办事处医院麻醉科,成都610041 [4]内江市第一人民医院麻醉科,四川内江641400

出　　处：《中国胸心血管外科临床杂志》2022年第6期717-723,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的评估术中液体输注量对微创腔镜食管癌切除患者术后肺部并发症(postoperative pulmonary complications,PPCs)的影响。方法从四川大学华西医院电子病历信息管理系统及麻醉手术临床信息系统中,回顾性纳入2019年6月—2021年8月期间486例行择期微创腔镜食管癌切除术患者,其中男381例、女105例,中位年龄64.0岁。以术后7 d内PPCs发生率为主要结局指标,通过回归分析,明确分析术中液体输注量与术后7 d内PPCs发生的相关性。结果全组患者术后7 d内PPCs发生率为33.5%(163/486)。回归分析显示,术中液体输注量与PPCs的发生相关[校正OR=1.089,95%CI(1.012,1.172),P=0.023],尤其是肺部感染[校正OR=1.093,95%CI(1.014,1.178),P=0.020]和胸腔积液[校正OR=1.147,95%CI(1.007,1.306),P=0.039];肺部感染发生率在低术中液体输注量组[<6.49 mL/(kg·h),n=115]显著低于高术中液体输注量组[≥6.49 mL/(kg·h),n=371](18.3%vs.34.5%,P=0.023)。术中液体输注量与术后30 d内死亡正相关[校正OR=1.442,95%CI(1.056,1.968),P=0.021]。结论对于择期微创腔镜食管癌切除术,术中液体输注量与术后7 d内PPCs的发生相关,尤其是肺部感染和胸腔积液,并且可能影响术后30 d内死亡。Objective To evaluate the effect of intraoperative fluid infusion volume on postoperative pulmonary complications(PPCs)in patients after minimally invasive endoscopic esophageal carcinoma resection.Methods From June 2019 to August 2021,486 patients undergoing elective minimally invasive endoscopic esophagectomy for esophageal cancer were retrospectively screened from the electronic medical record information management system and anesthesia surgery clinical information system of West China Hospital of Sichuan University.There were 381 males and 105 females,with a median age of 64.0 years.Taking the incidence of pulmonary complications within 7 days after operation as the primary outcome,the correlation between intraoperative fluid infusion volume and the occurrence of PPCs within 7 days was clearly analyzed by regression analysis.Results The incidence of pulmonary complications within 7 days after surgery was 33.5%(163/486).Regression analysis showed that intraoperative fluid infusion volume was correlated with the occurrence of PPCs[adjusted OR=1.089,95%CI(1.012,1.172),P=0.023],especially pulmonary infection[adjusted OR=1.093,95%CI(1.014,1.178),P=0.020],and pleural effusion[adjusted OR=1.147,95%CI(1.007,1.306),P=0.039].Pulmonary infection was significantly less in the low intraoperative fluid infusion group[<6.49 mL/(kg·h),n=115]compared with the high intraoperative fluid infusion group[≥6.49 mL/(kg·h),n=371](18.3%vs.34.5%,P=0.023).Intraoperative fluid infusion volume was positively associated with death within 30 days after surgery[adjusted OR=1.442,95%CI(1.056,1.968),P=0.021].Conclusion Among patients undergoing elective minimally invasive endoscopic esophageal cancer resection,intraoperative fluid infusion volume is related with the occurrence of PPCs within 7 days after the surgery,especially pulmonary infection and pleural effusion,and may affect death within 30 days after the surgery.

关 键 词：术中液体输注量 微创腔镜食管癌切除术 术后肺部并发症 

分 类 号：R735.1[医药卫生—肿瘤]