经口寰枢椎手术后肺部并发症的相关因素分析

目的 探讨经口寰枢椎手术后肺部并发症(PPCs)的相关因素,为临床防治提供参考依据.方法 收集104例行经口寰枢椎术患者的临床资料,评价术后肺部并发症情况,分为PPCs组与非PPCs组,比较两组患者围术期观察项目的 差异性,并进行logistic回归多因素分析.结果 本组104例患者中23例出现PPCs,发生率22.1%.PPCs组与非PPCs组比较结果显示,气管导管留置时间、术中输液量、手术时间、气管切开、脊髓损伤程度(Frankle分级)、吸烟史、低蛋白血症(血清清蛋白＜35g/L)、低钠血症(血清钠＜135 mmol/L)及术前低体质量指数(BMI＜18.5)等9个因素差异有统计学意义;多因素分析结果显示,血清清蛋白＜35 g/L、气管切开、脊髓损伤程度(Frankle分级)、气管导管留置时间＞4 d、手术时间＞6 h等5个因素与PPCs有关.结论 血清清蛋白＜35 g/L、气管切开、脊髓损伤程度(Frankle分级)、气管导管留置时间＞4 d、手术时间＞6 h为PPCs的独立危险因素.

Risk factors for postoperative pulmonary complications following transoral operation for the atlantar axis disorders

Objective To evaluate the risk factors for postoperative pulmonary complications following transoral operation for the atlantar-axis disorders. Methods Total 104 cases were collected from January 2005 to June 2009. Twelve variables among patients with PPCs and without PPCs were analyzed by logistic regression analysis. Results The incidence of postoperative pulmonary complications following transoral operation for the atlantar-axis disorders was 22. 1% (23/104). There was significantly difference in 9 variables between patients with PPCs and without PPCs , and 5 variables as serum albumin ＜ 35 g/L( OR =15. 185,P =0. 003), tracheotomy( OR = 32. 254 ,P=0. 015), Frankle grade(OR =8. 866,P =0. 001) ,the duration of intubation ＞4 d ( OR = 7. 934, P = 0. 002 ), the duration of surgery ＞ 6 h ( OR = 16. 889, P =0. 006) were found to be significantly related to the development to postoperative pulmonary complications by multivariate analysis. Conclusion Serum albumin ＜35 g/L, tracheotomy, Frankle grade, the duration of intubation ＞4 d, the duration of surgery ＞6 h are the risk factors for postoperative pulmonary complications following transoral operation for the atlantar-axis disorders.