高原医疗中心开展高原地区患者胸外科手术的安全性分析  

Safety and feasibility of thoracic surgery for high-altitude patients in the high-altitude medical center

作　　者：戢艳丽 降初拉尔布 王文凭[2] 胡杨[2] 马林[2] 袁勇[2] 林锋[2] 车国卫[2] JI Yanli;JIANG Chulaerbu;WANG Wenping;HU Yang;MA Lin;YUAN Yong;LIN Feng;CHE Guowei(Department of Thoracic Surgery,West China Hospital,Sichuan University/School of Nursing,Sichuan University,Chengdu,610041,P.R.China;Department of Thoracic Surgery,West China Hospital,Sichuan University,Chengdu,610041,P.R.China;Department of Thoracic Surgery,People's Hospital of Ganzi Tibetan Autonomous Prefecture,Kangding,626000,Sichuan,P.R.China)

机构地区：[1]四川大学华西医院胸外科/四川大学华西护理学院,成都610041 [2]四川大学华西医院胸外科,成都610041 [3]甘孜藏族自治州人民医院胸外科,四川康定626000

出　　处：《中国胸心血管外科临床杂志》2023年第1期95-99,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的研究高原居民患者在当地医疗中心行胸外科手术的安全性。方法收集2013年1月—2019年7月54例在四川大学华西医院(平原医疗中心)和204例在甘孜藏族自治州人民医院(高原医疗中心)接受胸外科手术的高原地区患者,其中男175例、女83例,平均年龄(43.0±16.8)岁。分析患者围术期指标、术后并发症及其相关危险因素。结果高原医疗中心微创手术率显著低于平原医疗中心(11.8%vs.55.6%,P<0.001);高原医疗中心患者结核性脓胸(41.2%vs.1.9%,P<0.001)、肺包虫病手术比例(15.2%vs.0.0%,P=0.002)显著高于平原医疗中心;高原医疗中心术后死亡率(0.5%vs.1.9%,P=0.379)及术后30 d内并发症发生率(7.4%vs.11.1%,P=0.402)与平原医疗中心差异无统计学意义。单因素及多因素分析发现,体重指数≥25 kg/m^(2)(OR=8.647,P<0.001)、食管破裂/穿孔(OR=15.720,P<0.001)是术后并发症发生的独立危险因素。结论高原居民患者在高原医疗中心开展胸外科手术总体安全、可行。Objective To investigate the safety of thoracic surgery for high-altitude patients in local medical center.Methods We retrospectively collected 258 high-altitude patients who received thoracic surgery in West China Hospital,Sichuan University(plain medical center,54 patients)and People’s Hospital of Ganzi Tibetan Autonomous Prefecture(high-altitude medical center,204 patients)from January 2013 to July 2019.There were 175 males and 83females with an average age of 43.0±16.8 years.Perioperative indicators,postoperative complications and related risk factors of patients were analyzed.Results The rate of minimally invasive surgery in the high-altitude medical center was statistically lower than that in the plain medical center(11.8%vs.55.6%,P<0.001).The surgical proportions of tuberculous empyema(41.2%vs.1.9%,P<0.001)and pulmonary hydatid(15.2%vs.0.0%,P=0.002)in the high-altitude medical center were statistically higher than those in the plain medical center.There was no statistical difference in perioperative mortality(0.5%vs.1.9%,P=0.379)or complication rate within 30 days after operation(7.4%vs.11.1%,P=0.402)between the high-altitude center and the plain medical center.Univariate and multivariate analyses showed that body mass index≥25 kg/m^(2)(OR=8.647,P<0.001)and esophageal rupture/perforation were independent risk factors for the occurrence of postoperative complications(OR=15.720,P<0.001).Conclusion Thoracic surgery in the high-altitude medical center is safe and feasible.

关 键 词：高原居民 高原医疗中心 胸外科手术 术后并发症 

分 类 号：R655[医药卫生—外科学]