老年患者开胸术后体液平衡管理与术后心肺并发症关系的观察

目的:探讨老年患者开胸术后体液平衡管理对预防术后并发症的意义。方法:对135例老年开胸手术患者,根据术后1~3天液体出入量进行分组,曾出现过液体出入明显正平衡(≥ 800ml)者为Ⅰ组,保持每日负平衡者为Ⅱ组,其他为Ⅲ组,比较三组的术后心肺并发症发生率。结果:Ⅰ组中9例术后出现不同程度心肺并发症,其中循环系统并发症5例,呼吸系统并发症8例,导致病死2例;Ⅱ组中有5例术后出现不同程度心肺并发症,其中循环系统并发症2例,呼吸系统并发症4例,无病死病例;Ⅲ组术后出现不同程度心肺并发症15例,其中循环并发症5例,呼吸并发症13例,导致病死1例。三组患者在循环系统并发症总发生率、严重心律失常、心力衰竭、呼吸系统并发症、肺部感染、哮喘、低氧血症、肺水肿、呼吸衰竭差异均有统计学意义(P<0.05~P<0.01);Ⅱ组低氧血症发生率显著减少,且未出现肺水肿及呼吸衰竭病例。结论:老年患者开胸术后早期应避免出现过量正平衡,通过限制性液体管理使正平衡尽早转入负平衡期,有助于减少术后心肺并发症的发生率和病死率。

Relations between body fluid balance and cardio-pulmonary complications in elderly patients after thoracotomy

Objective：To explore the significance of body fluid balance in prevention of cardio-pulmonary complications in elderly patients after thoracotomy.Methods：One hundred and thirty-five elderly patients undergoing thoracotomy were grouped according to the volume of liquid in 1-3 days after thoracic surgery.The cases with positive balance of body fluid（≥800 ml）were enrolled in groupⅠ,cases maintaining negative balance in groupⅡ and the others in group Ⅲ.A retrospective analysis and comparison about the incidence of cardio-pulmonary complications were made among the three groups.Results：In group Ⅰ,9 cases presented postoperative cardio-pulmonary complications,including 5 cases of cardiovascular complications and 8 cases of respiratory complications,and 2 patients died;in group Ⅱ,5 cases presented postoperative cardio-pulmonary complications,including 2 cases of cardiovascular complications and 4 cases of respiratory complications,and no one died;in group Ⅲ,15 cases developed postoperative cardio-pulmonary complications,including 5 cases of cardiovascular complications and 13 cases of respiratory complications,and 1 patient died.The incidences of arrhythmia,heart failure,lung infections,asthma,hypoxemia,pulmonary edema and respiratory failure complications differed significantly among the three groups（P〈0.05-P〈0.01）.In group Ⅱ,the incidence of hypoxemia had a significant reduction and no pulmonary edema or respiratory failure occurred.Conclusions：Positive fluid balance should be avoided in the elderly patients early after thoracotomy.Positive fluid balance may be turned to negative fluid balance by controlling the liquid input,which would contribute to the reduction of morbidity and mortality due to postoperative cardiopulmonary complications.