长居高海拔地区患者返回平原后行非心胸手术术后肺部并发症的调查  

Investigation of pulmonary complications after non-cardiothoracic surgery in patients living at high altitude after returning to the plain:a single-center and prospective,cohort study

作　　者：朱婵 完玛龙主 虞夏 尚凯茜 吴江 ZHU Chan;WANMA Longzhu;YU Xia;SHANG Kaixi;WU Jiang(Department of Anesthesiology,Chengdu Office of the People’s Government of Tibet Autonomous Region,Chengdu,Sichuan 610041,China;Department of Anesthesiology,Chengfei Hospital,Chengdu,Sichuan 610000,China)

机构地区：[1]西藏自治区人民政府驻成都办事处医院麻醉科,成都610041 [2]成飞医院麻醉科,成都610000

出　　处：《重庆医学》2023年第19期2887-2891,共5页Chongqing medicine

基　　金：2020年西藏自治区自然科学基金项目(XZ202001ZR0045G);2021年西藏自治区自然科学基金项目(XZ202101ZR0049G);2020年西藏自治区人民政府驻成都办事处医院院级科研项目(2020YJYB-3)。

摘　　要：目的探索高原脱习服患者行非心胸手术术后肺部并发症(PPCs)发生情况,评估高原环境对术后肺部并发症的影响。方法选取2021年1-11月于西藏自治区人民政府驻成都办事处医院拟行非心胸手术治疗的患者233例,返回平原后行非心胸手术的高原暴露患者113例为观察组(L组),选择无高原旅居史的平原患者120例作为对照组(C组)。两组术中均采用国际公认的肺保护性通气策略。记录两组入手术室时(T1)、气管插管后5 min(T2)、手术开始后30 min(T3)、手术结束前5 min(T4)、出恢复室时(T5)的脉搏血氧饱和度(SpO 2)和动脉血气分析值。比较两组患者各时间点的SpO 2、动脉血氧分压(PaO 2)、动脉血二氧化碳分压(PaCO 2)及术后7 d肺部并发症的发生情况。结果L组在T1、T5时间点的SpO 2(94.3%±3.9%、88.8%±2.5%)明显低于C组(97.2%±2.7%、94.6%±2.2%),差异有统计学意义(P<0.05)。同时,L组在T1、T5时的PaO 2分别为(73.5±3.1)、(64.3±9.6)mmHg,明显低于C组[(100.0±2.5)、(132.9±21.4)mmHg],差异有统计学意义(P<0.05)。L组术后7 d肺部并发症的发生率、住院时间和住院总费用分别是13.3%、(14.6±10.9)d、(43272.0±25550.6)元,明显高于C组[3.3%、(9.3±5.1)d、(34590.7±14177.5)元],差异有统计学意义(P<0.05)。结论近5年高原脱习服期人群行非心胸手术,术后7 d肺部并发症发生率、住院时间和住院总费用明显增加。Objective To explore the incidence of postoperative pulmonary complications(PPCs)after non-cardiothoracic surgery in patients with high altitude acclimatization,and to evaluate the impact of high altitude environment on postoperative pulmonary complications.Methods From January to November,2021,a total of 233 patients exposed to high altitude environmental who underwent non-cardiothoracic surgery in Chengdu Office Hospital of Tibet Autonomous Region People’s Government were selected as the observation group(L group),and 120 patients with high altitude environmental exposure who had no history of living at high altitude were selected as the control group(C group).The internationally recognized lung protective ventilation strategy(LPVS)was adopted in both groups.The pulse oxygen saturation(SpO 2)and arterial blood gas analysis values of the two groups were recorded at the time of entering the operating room(T1),5 minutes after tracheal intubation(T2),30 minutes after the operation(T3),5 minutes before the operation(T4),and at the time of leaving the recovery room(T5).The SpO 2,PaO 2,PaCO 2 and PPCs seven days after operation at each time point were compared between the two groups.Results The SpO 2 of the group L at T1 and T5 was 94.3%±3.9%and 88.8%±2.5%,respectively,which was significantly lower than that of the group C at T1 and T5(97.2%±2.7%and 94.6%±2.2%,P<0.05).At the same time,the PaO 2 of the group L at T1 and T5 was(73.5±3.1)mmHg and(64.3±9.6)mmHg,respectively,which was significantly lower than that of the group C(100.0±2.5)mmHg and(132.9±21.4)mmHg,and the difference was statistically significant(P<0.05).Seven days after operation,the incidence,hospitalization time and total hospitalization expenses of PPCs in the group L were 13.3%,(14.6±10.9)d,and(43272.0±25550.6)yuan,respectively,which were significantly higher than those in the group C of 3.3%,(9.3±5.1)d,and(34590.7±14177.5)yuan(P<0.05).Conclusion In the past five years,the incidence of pulmonary complications,length of stay and total hospi

关 键 词：脱习服 肺部并发症 肺保护性通气 高海拔 

分 类 号：R563[医药卫生—呼吸系统]