恶性肿瘤切除术患儿术后肺部并发症的危险因素  

Risk factors for postoperative pulmonary complications in pediatric patients undergoing malignant tumor resection

作　　者：张小蝶 赵佳莲 王文洋 蔡彬彬 胡瑶琴[1] Zhang Xiaodie;Zhao Jialian;Wang Wenyang;Cai Binbin;Hu Yaoqin(Department of Anesthesiology,Children′s Hospital,Zhejiang University School of Medicine National Clinical Research Center for Child Health,Hangzhou 310057,China)

机构地区：[1]浙江大学医学院附属儿童医院麻醉科,国家儿童健康与疾病临床医学研究中心,杭州310057

出　　处：《中华麻醉学杂志》2024年第9期1081-1085,共5页Chinese Journal of Anesthesiology

摘　　要：目的:筛选恶性肿瘤切除患儿术后肺部并发症(PPCs)的危险因素。方法:回顾性收集2019年8月至2023年7月在浙江大学医学院附属儿童医院接受开腹腹部恶性肿瘤切除术患儿的病历资料,住院时间≥48 h。根据术后7 d内是否发生PPCs分为PPCs组和非PPCs组(non-PPCs组)。将差异性检验中P<0.05的变量纳入二元logistic回归分析,筛选PPCs的危险因素。结果:最终纳入605例腹部恶性肿瘤切除术患儿,其中391例患儿发生PPCs,发生率为64.6%。二元logistic回归结果显示,体质量(P=0.001)、ASA分级(P<0.001)、术前低白蛋白血症(P=0.013)、术前化疗(P=0.003)、肿瘤压迫/包绕腹部大血管(P=0.002)、麻醉时间(P<0.001)、术中入量(ml·kg^(-1)·h^(-1),P<0.001)、术中使用降压药(P=0.047)、合并经腹纵隔肿瘤切除术(P<0.001)是恶性肿瘤切除术患儿PPCs的危险因素,年龄(P<0.001)是PPCs的保护因素。结论:体质量、ASA分级、术前化疗、术前低白蛋白血症、肿瘤压迫/包绕腹部大血管、麻醉时间、术中入量、术中使用降压药和合并经腹纵隔肿瘤切除术是开腹恶性肿瘤切除术患儿PPCs的危险因素,年龄是PPCs的保护因素。ObjectiveTo identify the risk factors for postoperative pulmonary complications(PPCs)in pediatric patients undergoing malignant tumor resection.MethodsMedical records of pediatric patients who underwent open abdominal malignant tumor resection at Children′s Hospital affiliated to Zhejiang University School of Medicine from August 2019 to July 2023,with length of hospital stay≥48 h,were retrospectively collected.Patients were divided into PPC group and non-PPC group based on the occurrence of PPCs within 7 days postoperatively.Variables with P<0.05 in the univariate analysis were included in the binary logistic regression analysis to identify the risk factors for PPCs.ResultsA total of 605 pediatric patients who underwent abdominal malignant tumor resection were finally included,among which 391 children developed PPCs,with an incidence of 64.6%.Binary logistic regression analysis showed that body weight(P=0.001),American Society of Anesthesiologists Physical Status classification(P<0.001),preoperative hypoalbuminemia(P=0.013),preoperative chemotherapy(P=0.003),tumor compression/encasement of major abdominal vessels(P=0.002),anesthesia duration(P<0.001),intraoperative fluid intake(ml·kg^(-1)·h^(-1),P<0.001),intraoperative use of hypotensive agents(P=0.047),and concurrent resection of mediastinal tumors via abdominal approach(P<0.001)were risk factors for PPCs in children undergoing malignant tumor resection.Age(P<0.001)was identified as a protective factor for PPCs.ConclusionsBody weight,American Society of Anesthesiologists Physical Status classification,preoperative chemotherapy,preoperative hypoalbuminemia,tumor compression/encasement of major abdominal vessels,anesthesia duration,intraoperative fluid intake,intraoperative use of hypotensive agents,and concurrent resection of mediastinal tumors via abdominal approach are risk factors for PPCs in pediatric patients undergoing open abdominal malignant tumor resection,whereas age is a protective factor for PPCs.

关 键 词：腹部肿瘤 手术后并发症 肺 危险因素 

分 类 号：R735[医药卫生—肿瘤] R726.1[医药卫生—临床医学]