老年病人肝切除手术后肺部并发症发生的危险因素分析  

Risk factors of postoperative pulmonary complications following hepatectomy in elderly patients

作　　者：姚辉华[1] 陈星宇 赖威[1] 胥楠[1] 邓蓉 陈乾 YAO Huihua;CHEN Xingyu;LAI Wei(Department of Hepatobiliary&Pancreas Surgery,Chengdu First Peoples Hospital,Sichuan,Chengdu 610041,China)

机构地区：[1]成都市第一人民医院(成都市中西医结合医院)肝胆胰脾外科,610041

出　　处：《临床外科杂志》2023年第3期247-250,共4页Journal of Clinical Surgery

基　　金：四川省医学会资助项目(S20062)。

摘　　要：目的研究影响老年病人肝切除术后肺部并发症(PPCs)发生的危险因素,探讨其精准的围手术期管理。方法2016年1月~2020年12月间在我院行肝切除手术的老年病人114例,根据术后发生PPCs与否分为PPCs组与对照组,单因素及多因素Logistic回归分析可能影响老年病人肝切除术PPCs发生的相关因素。结果114例病人中,术后发生PPCs36例(31.6%,PPCs≥1种),其中ARDS1例,肺不张10例,胸腔积液19例,肺部感染26例。单因素分析显示,两组病人年龄、吸烟史、术前存在肺部合并症等比较,差异有统计学意义,老年肝切除术PPCs的发生与肝切除类型、手术持续时间和术中出血量有相关性(P<0.05)。Logistic回归分析显示,病人的年龄、吸烟史、术前肺部合并症、手术持续时间及术中出血量是老年肝切除术PPCs发生的独立危险因素(P<0.05)。结论年龄、吸烟史、术前肺部合并症、手术持续时间及术中出血量是老年病人肝切除术PPCs发生的危险因素,对其评估有助于选择的合适治疗方案与围手术期管理,提高手术治疗的疗效与安全性。Objective To determinate the risk factors of postoperative pulmonary complications(PPCs)after hepatic resection for elderly patients and explore the precise perioperative managements.Method The clinical data of 114 elderly patients who underwent hepatectomy in our hospital between January 2016 and December 2020 were collected.They were divided into PPCs group and control group according to occurrence of PPCs,and statistical analysis was conducted to explore the relevant factors that could affect the occurrence of postoperative pulmonary complications after liver resection in elderly patients.Results114 elderly patients with liver resections were included.Postoperative pulmonary complications occurred in 36(31.6%,PPCs≥1)patients,including 1 ARDS,10 atelectasis,19 pleural effusions,and 26 pneumonias.Univariate analysis showed that PPCs were statistically different between the age of patients,smoking history,and pulmonary comorbidities before surgery,and were related to the type of liver resection,duration of surgery,and intraoperative blood loss(P<0.05).Logistic regression analysis showed that the age of patients,smoking history,preoperative pulmonary comorbidities,operation duration and intraoperative blood loss were the independent risk factors for PPCs after hepatectomy in the elderly patients(P<0.05).Conclusion Age,smoking history,preoperative pulmonary comorbidities,duration of operation,and intraoperative blood loss were the risk factors for pulmonary complications after hepatectomy in the elderly patients.Evaluation could help to select appropriate treatment and perioperative management for the elderly patients with hepatectomy.

关 键 词：老年 肝切除术 术后肺部并发症 危险因素 

分 类 号：R657.3[医药卫生—外科学]