老年患者开胸术后心肺并发症发生原因分析

目的 探讨老年重症患者开胸手术后心肺并发症的发生原因和预防措施。方法 对2001年7月至2003年12月收治的58例年龄〉65岁、术前有重要器官合并症和行大手术的开胸手术患者（实验组）进行围术期呼吸、循环监测，观察术后并发症发生情况，并与同期收治的56例（65岁开胸手术患者（对照组）进行比较。结果 实验组患者术前合并心血管和呼吸系统疾病的比率显著高于对照组，肺功能指标均较对照组差（P〈0．05）。实验组死亡4例，术后并发症、功能性并发症发生率显著高于对照组58．6％（34／58）vs．17．9％（10／56），P=0.000；51．7％（30／58）vs．12．5％（7／56），P=0.000]，呼吸系统并发症发生率明显较对照组高。logistic回归分析显示，术前呼吸系统合并症（OR=5．4）和肥胖（OR=4．9）是术后呼吸系统并发症发生的独立预测因素。结论 术前合并呼吸系统、心血管疾病是老年患者术后易发生呼吸、心血管系统功能性并发症的主要原因。呼吸系统并发症是老年重症患者开胸手术后主要的死亡原因。术前呼吸系统合并症、肥胖是术后发生呼吸系统并发症的主要危险因素。心血管并发症主要表现为阵发性室上性心动过速，术前有心血管合并症是术后发生心血管并发症的危险因素。密切监护老年患者的呼吸循环指标及液体出入平衡变化有助于及早发现呼吸循环异常，提高老年患者开胸手术的疗效。

Analysis of the Causes of Cardiopulmonary Complications in Elderly Patients after Thoracotomy

Objective To investigate the causes and prevention of cardiopulmonary complications in elderly patients after thoracotomy.Methods Respiratory and circulatory status were monitored and postoperative complications were documented in 58 elderly patients either aged over 65 years,with major organ dysfunction or underwent highly invasive procedures(experimental group) during July 2001 to Dec.2003.The results were compared with those from 56 young patients(<65 years) receiving thoracotomy in the same period(control group).(Results Patients) in experimental group had significantly more preoperative cardiopulmonary co-morbidities and poorer spirometry than those in control group(P<0.05).Four patients died after operation in experimental group.There were significantly more postoperative complications in experimental group than those in control group 58.6%(34/58) vs.17.9%(10/56),P=0.000],especially functional complications 51.7%(30/58) vs.12.5%(7/56),P=0.000].The rate of respiratory complications was also significantly higher in the experimental group.Multi-variance logistic regression showed that preoperative pulmonary morbidity(OR=5.4) and obesity(OR=4.9) were independent risk factors for pulmonary complications after thoracotomy in elderly patients.Conclusions Cardiopulmonary co-morbidities commonly seen are responsible for surgical morbidities,especially the functional complications in elderly patients underwent thoracotomy.Respiratory complications are the major causes of death in the elderly after thoracotomy.Pulmonary co-morbidity and obesity are independent risk factors for respiratory complications.Supraventricular tachycardia is the major type of cardiovascular complications after thoracotomy and is predicted by preoperative cardiovascular morbidity.Close monitoring of cardiopulmonary status of the elderly may identify patients at risk in developing functional complications and help improve surgical outcome.