新型冠状病毒肺炎疫情背景下胸外科术后肺部并发症的应对策略  

Postoperative pulmonary complications following thoracic surgery during COVID-19 pandemic

作　　者：阳茂丹 牛玲莉 伍伫[2] 刘成武[2] 张小龙[2] 王文凭[2] YANG Maodan;NIU Lingli;WU Zhu;LIU Chengwu;ZHANG Xiaolong;WANG Wenping(Department of Thoracic Surgery,Shangjin Nanfu Hospital(Shangjin Branch of West China Hospital),Chengdu,611743,P.R.China;Department of Thoracic Surgery,West China Hospital,Sichuan University,Chengdu,610041,P.R.China)

机构地区：[1]成都市上锦南府医院(四川大学华西医院上锦院区)胸外科,成都611743 [2]四川大学华西医院胸外科,成都610041

出　　处：《中国胸心血管外科临床杂志》2022年第8期1024-1030,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的探索新型冠状病毒(新冠)肺炎疫情背景下,胸外科术后发热和肺部并发症的处理策略。方法回顾性分析2020年2—12月四川大学华西医院上锦院区胸外科行择期手术537例患者的围术期资料,其中男242例(45.1%)、女295例(54.9%),平均年龄(53.3±13.4)岁。针对胸外科术后出现发热和肺部并发症患者,尽快进行病因追溯和风险排查,我们制定了配套的应对流程。针对纳入流程的患者,分析与术后发热和肺部并发症相关的影响因素。结果术后总体并发症发生率为16.4%(88/537),共1例(0.2%)患者死亡。共有179例(33.3%)患者进入筛查处理流程,其中男性[112例(62.6%)vs.130例(36.3%),P<0.010]、有吸烟史患者[74例(41.3%)vs.87例(24.3%),P<0.010]、食管癌手术[36例(20.1%)vs.15例(4.2%)]、开放手术[14例(7.8%)vs.4例(1.1%)]较未进入筛查流程的患者比例高。因发热或肺部并发症进入处理流程的患者,术后住ICU时间和术后总住院时间均延长(P=0.010)。多因素logistic回归分析显示:性别是术后发热或肺部并发症的独立危险因素。结论在疫情低风险地区,该处理流程简便可行,24 h内基本就可以完成病因追溯和对应处理,同时,该处理流程长期运行稳定。Objective To explore the treatment strategies for patients with fever and pulmonary complications after thoracic surgery during COVID-19 epidemic.Methods The clinical data of 537 patients who ungerwent selective surgery at the Department of Thoracic Surgery,Shangjin Branch of West China Hospital between February and December 2020 were retrospectively analyzed,including 242(45.1%)males and 295(54.9%)females aged 53.3±13.4 years.We have established a procedure for the patients with fever and pulmonary complications after thoracic surgery to investigate the cause of the disease and track risk factors.Results The overall postoperative complication rate was 16.4%(88/537),and 1(0.2%)patient died.Of 537 patients,179(33.3%)patients were enrolled in our model according to the inclusion criteria:ratio of males[112(62.6%)vs.130(36.3%),P<0.010],patients with a history of smoking[74(41.3%)vs.87(24.3%),P<0.010],or with esophageal cancer surgery[36(20.1%)vs.15(4.2%)],or with traditional thoracotomy[14(7.8%)vs.4(1.1%)]was higher than that of the other patients.Patients in our process due to fever or pulmonary complications had longer ICU stay and postoperative hospital stay(P=0.010).Logistic regression multivariate analysis showed that gender was an independent risk factor for postoperative fever or pulmonary complications.Conclusion In low-risk areas of the epidemic,the treatment process is simple and feasible,and the cause traceability and corresponding treatment can basically be completed within 24 hours.At the same time,the treatment process has been running stably for a long time.

关 键 词：胸外科 术后并发症 发热 肺部并发症 新型冠状病毒肺炎 

分 类 号：R655[医药卫生—外科学]