食管癌术后肺部并发症危险因素的多因素Logistic回归分析

目的 分析食管癌术后需要机械通气支持患者肺部并发症的危险因素,以利于术前对高风险的患者制定个体化治疗方案.方法 回顾性分析本院2008年5月至2010年6月82例经手术治疗食管癌患者的临床资料,应用多因素Logistic回归分析方法鉴别食管癌术后肺部并发症的危险因素.结果 82例接受手术治疗的食管癌患者术后共有12例发生了肺部并发症,术后死亡1例.多因素Logistic回归分析显示,术后肺部并发症的独立预测因子有高龄[优势比(OR)=1.28,95%可信区间(95%CI)为1.05～1.62,P=0.03]、肺功能受损[1秒用力呼气容积(FEV1%)OR=1.20,95%CI为1.08～1.39,P=0.02]和较长的手术时间(OR=1.68,95 %CI 为1.37～2.11,P=0.003).结论 高龄和肺功能受损是食管癌术后肺部并发症的危险因素,术前应评估患者发生术后肺部并发症的风险.对于高风险的患者,可以从个体化的治疗方案中获益.

Risk factors for post-surgical pulmonary complications in patients after esophagectomy for cancer: a multivariate logistic analysis

Objective To identify risk factors for post-surgical pulmonary complications in patients with mechanical ventilation for respiratory failure and pneumonia after esphagectomy in order to guide the development of individualized treatment-plan for high risk patients.Methods Clinical data from 82 patients received esophagectomy for cancer during May 2008 to June 2010 were analyzed retrospectively using Logistic regression for risk factors associated with the development of post-surgical pulmonary complication Results Post-surgical pulmonary complications was found in 12 0ut of the 82 patients studied,and it was the primarily death cause for one of them.Multivariate Logistic analysis identified advanced age [odds ratio (OR) ～ 1.28,95% confidence interval (95%CI) 1.05 - 1.62,P= 0.03l,impaired pulmonary function (forced expiratory volume in one second (FEVi) OR = 1.20,95%CI l.08 - 1.39,P = 0.02) and longer operation duration (OR = 1.68,95%CI l.37 - 2.11,P= 0.003) as risk factors.Conclusion Advanced age and impaired lung function may be significant risk factors for pulmonary complications after esophagectomy.It is helpful to evaluate the risk of such complications by referring to these indexes before the surgery,and design individualized treatment-plan for patients at high risk.