食管癌术后呼吸衰竭的相关危险因素分析及预防措施

  目的  探讨食管癌术后发生呼吸衰竭的相关危险因素。  方法  应用Logistic逐步回归分析法对新乡市中心医院在2005年1月至2010年6月期间, 食管癌术后发生呼吸衰竭的63例患者与63例术后未发生呼吸衰竭者经行病例一对照分析。  结果  肺部疾病史、吸烟、肺功能损坏、手术时间、管状胃、术后并发症及术前心脏疾病这7个相关因素与术后呼吸衰竭的发生有显著关系, 其中管状胃为保护性因素(β < 0);对病例组进行分析发现术前肺功能中度或重度损害、有基础肺疾病、插管及呼吸机使用时间较长、术后出现相关并发症者, 其术后发生呼吸衰竭且死亡风险明显增加(P < 0.05)。  结论  重视对呼吸衰竭危险因素的防治可有效减少呼吸衰竭的发生。      

肺癌术后呼吸功能衰竭的原因分析

目的　探讨肺癌术后发生呼吸功能衰竭的原因。方法　 192例肺癌病人均在双腔支气管插管静脉复合麻醉下分别行不同术式的外科治疗 ,并对术后发生呼吸衰竭的临床资料进行分析。结果　全组手术病人术后发生呼吸衰竭 12例 (6.3 % ) ,其中男 8例、女 4例 ,年龄 41～ 71岁 ,60岁以上者 8例。术后呼吸衰竭组的术前肺功能指标 (VC %、MVV %、FEV1%或FEV1)均明显低于无呼吸衰竭组 (P <0 .0 1)。全肺切除术后发生呼吸衰竭明显高于肺叶切除及其它术式 (P <0 .0 1)。结论　肺癌术后发生呼吸衰竭主要原因与术前肺功能及手术方式直接相关 ,术前VC %、MVV % <60 %、FEV1% <5 0 %或FEV1<1.5L易发生呼吸衰竭 ,手术切除范围大也易发生呼吸衰竭。此外 ,患者的年龄与术后呼吸衰竭有密切关系。     

食管癌术后呼吸衰竭的早期防治

 呼吸衰竭，尤其是急性呼吸衰竭，是食管癌、贲门癌术后严重的并发症，治疗困难，死亡率较高，特别是长期大量吸烟、高龄、慢性肺组织疾患者更易发生，多发生于术后48小时内。早期预防，早期防治，早期发现，早期治疗，彻底清除呼吸道分泌物，控制肺内感染是抢救成功的关键。     

应用900C型器呼吸抢救胸外科术后呼吸衰竭(附15例临床分析)

<正> 本文报告应用900C型呼吸器抢救胸外术后呼吸衰竭15例。肺癌7例,食管癌、纵隔肿瘤各2例,肺结核、胸外伤、肺大泡各1例。肺功能明显减损者5例。术后出现肺炎、肺不张等并发症10     

肺癌术后呼吸衰竭26例分析

目的　探讨肺癌术后呼吸衰竭的原因、预防及治疗。方法　对我院1990年1月至1997年10月肺癌术后发生呼吸衰竭的26例患者均进行了机械通气治疗,19例行气管切开术。结果　术后呼吸衰竭发生率4.7%(26/558),死亡率23.1%(6/26)。结论　呼吸道感染、手术创伤、伤口疼痛刺激、术前心肺功能异常等是引起术后呼吸衰竭的主要原因。尽早诊断、及时行气管切开术并给予机械通气是抢救成功的最有效手段,加强围手术期呼吸道管理、避免手术并发症是预防术后呼吸衰竭的关键。     

肺癌合并慢性阻塞性肺疾病患者围手术期气道管理现状

肺癌患者均合并不同程度的慢性阻塞性肺疾病（chronic obstructive pulmonary disease, COPD）,而COPD导致的肺功能降低对其能否手术治疗及术后并发症发生具有重要的影响。研究证明围手术期气道管理可以有效改善患者肺功能且减少术后并发症。本文针对近年来气道管理的临床应用现状及进展进行综述,主要有以下几方面：①围手术期气道管理的必要性;②围手术期气道管理的药物治疗现状与特点;③围手术期应用气道管理在改善肺功能中的价值;④围手术期需要气道管理的最佳人群;⑤围手术期气道管理应用存在的问题。     

肺功能不全肺癌患者术后的护理

目的:对肺功能不全肺癌术后患者加强呼吸道管理,以预防和减少术后呼吸道并发症的发生.方法:对63例肺功能不全肺癌术后患者,加强心理护理,密切监测肺部功能,加强胸部物理疗法,协助正确彻底的咳嗽、排痰.结果:55例无肺部并发症,8例发生肺部感染,其中3例发生呼衰,积极抗感染及加强呼吸道护理后好转7例,1例治疗无效死亡.其余全部治愈出院.结论:预防肺部并发症的积极干预措施,可以减少肺功能不全肺癌患者术后呼吸道并发症的发生.     

肺功能不全肺癌患者术后的护理

目的:对肺功能不全肺癌术后患者加强呼吸道管理,以预防和减少术后呼吸道并发症的发生。方法:对63例肺功能不全肺癌术后患者,加强心理护理,密切监测肺部功能,加强胸部物理疗法,协助正确彻底的咳嗽、排痰。结果:55例无肺部并发症,8例发生肺部感染,其中3例发生呼衰,积极抗感染及加强呼吸道护理后好转7例,1例治疗无效死亡。其余全部治愈出院。结论:预防肺部并发症的积极干预措施,可以减少肺功能不全肺癌患者术后呼吸道并发症的发生。     

食管癌和贲门癌术后呼吸衰竭的原因及防治(附12例分析〕

呼吸衰竭（以下简称呼衰）是食管癌和贲门癌手术后严重的肺部并发症，是导致死亡的主要原因之一。现将我院1990年7月至1995年7月所治疗12例食管癌和贲门癌术后呼衰病人的资料分析如下：临床资料本组问例中男11例，女1例。年龄56－74岁，60岁以上8例。长期吸烟史9例。慢性呼吸道疾患7例。其中4例肺功能低下。均为左侧开胸，主动脉弓上吻合7例；弓下吻合5例。术后呼衰原因：呼吸道感染6例；慢性阻塞性肺疾患（COPD）3例；吻合口疾四例；呼吸窘迫综合症（ANDS）l例；术中大出血1例。治疗及结果1气管切开与气管内插管。术前肺功能低下并伴有…     

食管、贲门癌术后急性呼吸衰竭的抢救

食管、贲门癌术后急性呼吸衰竭的抢救洪明陈金坝食管癌贲门癌术后发生急性呼吸衰竭，是一种严重的并发症，死亡率高。我院肿瘤科自１９８６年３月至１９９６年１月施行食管癌贲门癌手术１７８例，其中发生术后急生呼吸衰竭１１例发生率约６．１％，现对发病原因及其抢救...     

肺癌术后发生急性呼吸窘迫综合征的发病特点及治疗

目的：探讨肺癌术后发生急性呼吸窘迫综合征（ARDS）的原因及防治措施,方法：回顾分析我院胸外科1993年于1998年17例肺癌病人术后发生ARDS的发病特点,可能的原因及防治方法,。结果：患者有长期慢性肺部疾患、高龄、高血压病者,术后容易发生ARDS。休克、肺挫伤和肺癌感染是发和ARDS的三大诱因,治疗应积极清除呼吸道分泌物,保持气道通畅,控制感染,利尿减轻肺水肿,尤其是尽早行气管插管或气管切开机械辅助通气为抢救成功的关键,结论：肺癌术后发生ARDS的原因复杂,其中体克、肺挫伤和肺部感染等多因素的作用是肺癌病人术后发生ARDS的主要原因,是早期积极的治疗有望降低ARDS的死亡率。     

食管癌手术前肺功能试验与术后急性呼吸窘迫综合征的相关性

背景与目的：急性呼吸窘迫综合征（ARDS,acute respiratory distress syndrome）是食管癌手术后的一严重并发症,死亡率高。术前肺功能状况极大地影响医师对患者治疗方案的选择及预后的判断．而二者之间的相关性国内外报道较少,本研究旨在探讨食管癌术前传统肺功能试验与术后发生ARDS的相关性,为临床诊断与治疗提供依据。方法：回顾性分析我院2000～2002年的1488例行开胸手术治疗的食管癌患者术前传统肺功能试验的三个主要指标：第一秒用力呼气量占预计值百分比（FEV1％）,第一秒用力呼气量与用力肺活量比值（FEV1／FVC）％,最大通气量占预计值百分比（MVV％）及其它因素如年龄、性别、术式、术前心功能、早期加强监护治疗等与术后发生ARDS的关系。结果：1488例患者中,49例术后发生ARDS。FEV1％、（FEV1／FVC）％、MVV％、年龄交互作用后与术后ARDS的发生明显正相关（P值分别为0．001,0．005,0．048）;术前重度肺功能受损的49例患者中,术后随即入ICU32例,发生ARDS2例,ARDS发生率6．2％,术后回病房17例中发生ARDS5例,ARDS发生率29．4％。术后早期加强监护治疗能明显降低ARDS发生（P〈0．05）。结论：传统肺功能试验与开胸术后ARDS的发生有一定相关性,术后早期加强监护治疗是预防术后ARDS的重要手段。     

Thoracotomy procedures effect cytokine levels after thoracoabdominal esophagectomy

Pulmonary complications together with surgical complications are the most frequent causes for morbidity and mortality after thoracoabdominal esophagectomy. The con-tinuous improvement of surgical techniques has led to a decrease in surgical complications, whereas up to 30% of the patients develop postoperative pulmonary complications such as acute lung injury (ALI) or even the more severe acute respiratory distress syndrome (ARDS), which are characterized by an acute inflammation in the lung parenchyma and the airspace. Evidence from several studies indicates that a complex network of inflammatory cytokines and mediators play a key role in mediation, amplification, and perpetuation of the process of lung injury and that the thoracotomy itself is a risk factor for developing ALI or ARDS. In this trial, the cytokine levels of IL6, IL8 and IL10 were measured and compared in 30 patients who had undergone an extended radical thoracoabdominal esophagectomy for esophageal cancer, via anterolateral thoracotomy (n=17) or posterolateral thoracotomy (n=13). Patients of both groups were similar in terms of age, sex and preoperative pulmonary function as well as in the anesthetic procedures they have undergone. All patients displayed significantly increased serum levels of IL6 and IL8 after thoracoabdominal esophagectomy. However, patients who were subjected to an anterolateral thoracotomy were reported with significantly higher serum levels of IL6 and IL8 compared to patients who had received a posterolateral thoracotomy. Thus, the choice of the thoracotomy method during the thoracoabdominal esophagectomy and the resultant cytokine levels may contribute to the occurrence of postoperative pulmonary complications and may have an impact on the extent and severity of the surgical stress.     

Pulmonary toxicities from targeted therapies: a review

Pulmonary toxicity is rarely seen with most commonly used targeted therapies. The endothelial growth factor receptor (EGFR) small-molecule tyrosine kinase inhibitors (TKIs) gefitinib and erlotinib can cause interstitial lung disease (ILD). BCR-ABL tyrosine kinase inhibitors imatinib and dasatinib can cause pleural effusions. Infusion-related bronchospasm is common with the monoclonal antibodies to EGFR cetuximab and panitumumab, and case reports of bronchiolitis and pulmonary fibrosis have been described. Up to one-sixth of patients taking mammalian target of rapamycin (mTOR) inhibitors get a reversible interstitial pneumonitis. Bevacizumab, the monoclonal antibody to vascular endothelial growth factor (VEGF), has been associated with hemoptysis and pulmonary embolism particularly in patients with squamous cell lung cancer. Infusion-related bronchospasms, acute respiratory distress syndrome (ARDS), and interstitial pneumonitis can be seen with the anti-lymphocyte monoclonal antibodies rituximab, ofatumumab, and alemtuzumab. While most pulmonary toxicities from these therapies are mild and resolve promptly with dose reduction or discontinuation, it is important for the clinician to recognize these potential toxicities when faced with treatment-related complications. Discerning these pulmonary adverse effects may help in making decisions on diagnostic testing and therapy, particularly for those with pulmonary and cardiovascular co-morbidities.     

Surgery after radiochemotherapy for stage III lung cancer: Postoperative complications and late results

Fifty-seven stage III lung cancer patients underwent radiochemotherapy and subsequent surgery. Forty radical (R?), six non-radical, and eleven exploratory operations were performed. Pneumonia (five cases), pulmonary insufficiency (one case), bronchial fistula (one case) were the major non-fatal complications. Four deaths due to adult respiratory distress syndrome (ARDS) or pulmonary embolism occurred. Sixty percent of the 10 patients who had no viable tumor at operation survived 3 years, as well as 41% of those who achieved a complete remission by resection and 11% of those with residual disease (R+) after operation. However, the 1- and 2-year survival rates were similar. The main pattern of failure in R? and R+ patients was extra- and intra-RT-field progression, respectively. A slightly higher rate of postoperative complications, with respect to current practice, was observed. However, data lead to argument on the improvement of locoregional control and long-term survival following radical surgery. © 1994 Wiley-Liss, Inc.     

治疗食管、贲门癌术后发生急性呼吸窘迫综合征的体会

 为探讨ARDS的防治措施, 本文分析了11例食管、贲门癌术后发生ARDS的发病特点及防治方法。 患者有长期慢性肺部疾患、高龄、高血压病者术后容易发生。 术中对肺组织的损伤及术中, 术后过量输液, 肺部感染及休克, 缺氧可能是术后发生ARDS的重要原因之一。 治疗应积极清除呼吸道分泌物, 辅助通气, 保持气道通畅, 控制肺部感染, 尤其是尽早行气管插管或气管切开为抢救成功的关键。 术前肺功能检查应结合临床来综合分析。     

Late medical complications and fatigue in Hodgkin's disease survivors.

PURPOSE: Long-term medical complications, such as cardiac, pulmonary, and thyroid dysfunction, are frequent among Hodgkin's disease survivors (HDSs). Chronic fatigue is also highly prevalent among HDSs. Few studies have explored possible etiologic explanations for fatigue. The aim of this study was to explore whether late cardiac, pulmonary, and thyroid complications after curative treatment for Hodgkin's disease (HD) may explain the high level of fatigue among HDSs. PATIENTS AND METHODS: Four-hundred fifty-nine patients treated for HD at the Norwegian Radium Hospital from 1971 to 1991 were included in a cross-sectional, follow-up study of subjective health status. Fatigue (physical [PF] and mental), was measured by the Fatigue Questionnaire. A subcohort of the HDSs (116 patients) treated from 1980 to 1988 were included in a separate study in which long-term cardiac, pulmonary, and thyroid complications were assessed. All patients had received radiotherapy, and 63 patients had received additional chemotherapy. The present study comprised 92 patients (mean age, 37 years; range, 23 to 56 years) who participated in both studies. RESULTS: HDSs with pulmonary dysfunction were more fatigued than HDSs with normal pulmonary function (PF 10.9 v 8.9; P <.05). Gas transfer impairment was the most prevalent pulmonary dysfunction, and three times as many patients with gas transfer impairment reported chronic fatigue (duration, 6 months or longer), compared with patients without pulmonary dysfunction (48% v 17%, P <.01). No associations were found between cardiac sequelae or hypothyroidism and fatigue. CONCLUSION: Pulmonary dysfunction is associated with fatigue in HDSs. Cardiac sequelae was not associated with fatigue in HDSs. We question the absence of an association between thyroid complications and fatigue.     

Postoperative pulmonary complications after preoperative chemoradiation for esophageal carcinoma: correlation with pulmonary dose-volume histogram parameters

PURPOSE: To clarify the relationship between the percentage of lung receiving low radiation doses with concurrent chemotherapy and the occurrence of postoperative pulmonary complications in the treatment of esophageal carcinoma. METHODS: From 117 patients who underwent preoperative chemoradiation for esophageal cancer at our institution between 1998 and 2002, we selected 61 patients for whom complete pulmonary dose-volume histogram (DVH) data were available and analyzed the incidence of pneumonia and acute respiratory distress syndrome (ARDS) in this group. All patients received concurrent chemoradiation therapy, and 39 patients also received induction chemotherapy before concurrent chemoradiation. The median age was 62 years, and the median radiotherapy dose was 45 Gy. The percentage of lung volume receiving at least 10 Gy (V10), 15 Gy (V15), and 20 Gy (V20) were recorded from each pulmonary DVH. RESULTS: Eleven (18%) of the 61 patients had pulmonary complications, 2 of whom died after progression of pneumonia. Pulmonary complications were noted more often (35% vs. 8%, p = 0.014) when the pulmonary V10 was > or =40% vs. <40% and when the V15 was > or /=30% vs. < 30% (33% vs. 10%, p = 0.036). An apparent increase in pulmonary complication rate when V20 was > or =20% vs. <20% (32% vs. 10%, p = 0.079) was not significant. None of the other factors analyzed (surgical procedure, tumor location, use of induction chemotherapy, use of concurrent taxane-based chemoradiation, or smoking history) was associated with the occurrence of pulmonary complications. The median hospital stay was 17 days for patients who had pulmonary complications vs. 12 days for patients who did not (p = 0.08). CONCLUSIONS: The use of multimodality therapy may require minimization of lung volume irradiation to levels lower than previously expected. Radiotherapy techniques that decrease the volume of lung receiving low radiation doses may significantly reduce the risk of this potentially life-threatening complication.     

Non-cardiogenic pulmonary edema complicating intermediate and high-dose Ara C treatment for relapsed acute leukemia

Infection, hemorrhage and adult respiratory distress syndrome (ARDS) are pulmonary complications occurring after remission induction therapy for acute leukemia. The aim of this study was to analyze the incidence of these causes by serial roentgenogram, clinical, microbiological and laboratory tests in 21 patients (pts) with relapsed acute leukemia (18 X myeloid, 3 X lymphoblastic), an AML-pt (acute myeloid leukemia) suffering from secondary leukemia, and three pts with primary refractory leukemia following treatment with intermediate (IM) and high-dose cytosine arabinoside (HD-Ara C), in combination with amsacrine (AMSA)(n = 19), etoposide (VP 16) (n = 5) or Mitoxantrone (n = 1). Eleven out of 25 pts developed pulmonary complications, one of them with massive hemoptysis and roentgenographic signs of pulmonary bleeding, one suffering from protracted shock after a tumor lysis syndrome, two pts showing symptoms of a cardiogenic pulmonary edema complicating severe Candida pneumonia in one case and legionnaires' disease in the other. Seven of the eleven pts had a non-cardiogenic pulmonary edema with respiratory failure 1-14 days after cessation of induction or consolidation therapy. In six of the seven, there were no signs of cardiogenic, infectious or metabolic reasons, including fluid overload, for the pulmonary edema, one had as a contributing factor a Candida infection of the lung. Three of the seven patients recovered, four died (two following IM and two after HD-Ara C). Other adverse side effects, clearly attributable to HD-Ara C, included delirious state (n = 3), generalized erythema (n = 3), acute pancreatitis (n = 2), acute abdomen (n = 1) and conjunctivitis in almost all patients.(ABSTRACT TRUNCATED AT 250 WORDS)     

Investigation of clinical and dosimetric factors associated with postoperative pulmonary complications in esophageal cancer patients treated with concurrent chemoradiotherapy followed by surgery

PURPOSE: To assess the association of clinical and especially dosimetric factors with the incidence of postoperative pulmonary complications among esophageal cancer patients treated with concurrent chemoradiation therapy followed by surgery. METHOD AND MATERIALS: Data from 110 esophageal cancer patients treated between January 1998 and December 2003 were analyzed retrospectively. All patients received concurrent chemoradiotherapy followed by surgery; 72 patients also received irinotecan-based induction chemotherapy. Concurrent chemotherapy was 5-fluorouracil-based and in 97 cases included taxanes. Radiotherapy was delivered to a total dose of 41.4-50.4 Gy at 1.8-2.0 Gy per fraction with a three-dimensional conformal technique. Surgery (three-field, Ivor-Lewis, or transhiatal esophagectomy) was performed 27-123 days (median, 45 days) after completion of radiotherapy. The following dosimetric parameters were generated from the dose-volume histogram (DVH) for total lung: lung volume, mean dose to lung, relative and absolute volumes of lung receiving more than a threshold dose (relative V(dose) and absolute V(dose)), and absolute volume of lung receiving less than a threshold dose (volume spared, or VS(dose)). Occurrence of postoperative pulmonary complications, defined as pneumonia or acute respiratory distress syndrome (ARDS) within 30 days after surgery, was the endpoint for all analyses. Fisher's exact test was used to investigate the relationship between categorical factors and incidence of postoperative pulmonary complications. Logistic analysis was used to analyze the relationship between continuous factors (e.g., V(dose) or VS(dose)) and complication rate. Logistic regression with forward stepwise inclusion of factors was used to perform multivariate analysis of those factors having univariate significance (p < 0.05). The Mann-Whitney test was used to compare length of hospital stay in patients with and without lung complications and to compare lung volumes, VS5 values, and absolute and relative V5 values in male vs. female patients. Pearson correlation analysis was used to determine correlations between dosimetric factors. RESULTS: Eighteen (16.4%) of the 110 patients developed postoperative pulmonary complications. Two of these died of progressive pneumonia. Hospitalizations were significantly longer for patients with postoperative pulmonary complications than for those without (median, 15 days vs. 11 days, p = 0.003). On univariate analysis, female gender (p = 0.017), higher mean lung dose (p = 0.036), higher relative volume of lung receiving > or = 5 Gy (V5) (p = 0.023), and smaller volumes of lung spared from doses > or = 5-35 Gy (VS5-VS35) (p < 0.05) were all significantly associated with an increased incidence of postoperative pulmonary complications. No other clinical factors were significantly associated with the incidence of postoperative pulmonary complications in this cohort. On multivariate analysis, the volume of lung spared from doses > or = 5 Gy (VS5) was the only significant independent factor associated with postoperative pulmonary complications (p = 0.005). CONCLUSIONS: Dosimetric factors but not clinical factors were found to be strongly associated with the incidence of postoperative pulmonary complications in this cohort of esophageal cancer patients treated with concurrent chemoradiation plus surgery. The volume of the lung spared from doses of > or = 5 Gy was the only independent dosimetric factor in multivariate analysis. This suggests that ensuring an adequate volume of lung unexposed to radiation might reduce the incidence of postoperative pulmonary complications.