肺癌患者围术期并发症发生的危险因素分析

目的分析肺癌患者围术期并发症发生的高危因素，并探讨其对肺癌手术安全性的预测价值，指导围术期处理。方法回顾性分析胸外科2000年8月～2008年8月接受手术治疗的409例肺癌患者的临床资料，对可能与术后并发症发生相关的因素进行多因素logistic回归分析。结果该组患者手术死亡率为4．16％（17／409），术后并发症发生率为12．47％（51／409），主要并发症包括肺部感染、肺不张、心律失常、呼吸衰竭、脓胸、支气管胸膜瘘、胸腔出血等。采用多因素logistic回归分析发现：〉70岁（OR=15．335）、吸烟指数〉400支年（OR=6．108）、合并重要器官基础疾病（OR=7．973）、行全肺切除术（OR=8．165）和一秒率（FEV1．0％）≤60％（OR=1．031）是肺癌患者手术围术期并发症发生的高危因素。结论对肺癌患者术前评估上述相关因素，可初步预测术后并发症发生的概率，为患者顺利渡过围术期和提高手术的安全性提供积极的临床指导。

Analysis of Risk Factors Correlated to Perioperative Complications of Patients with Lung Cancer

Objective To Analyze the high risk factors correlated to the perioperative complications of patients with lung cancer,aiming to study their predictive value on surgical safety and guide the perioperative treatment. Methods The clinical experience of 409 lung cancer patients undergoing operation from Aug 2000 toAug 2008 were retrospectively study.The risk factors which closely related to the occurrence of postoperative complications were analyze by multivariate statistical analysis with logistic regression.Results The operative mortality was 4. 16%（17/409）,and the incidence rate of postoperative complications was 12.47%（51/409）,including pulmonary , infection,pulmonary atelectasis,arrhythmia,respiratory function failure,empyema, bronchopleural fistula,thoracic bleeding, etc.Multivariate statistical analysis with logistic regression demonstrated that the risk factors which closely related to the occurrence of postoperative complications were age over 70 year （OR=1 5.335）,smoking index over 400 piece year （OR=6.108）,concomitance with diseases of vital organs （OR =7.973）,modus operandi of pneumonectomy（OR=8.165）,forced expiratory volume in one second （FEV 1.0%） ≤ 60%（OR=1.031）.Conclusion To evaluate above factors of lung cancer patients before operation,the probability of postoperative complications occurrence can be roughly forecasted.This can provide actively clinical guide to help the patients overcome the perioperation successfully and to increase the safety of surgery.