食管癌术后发生呼吸衰竭的危险因素

目的探讨食管癌术后发生呼吸衰竭的危险因素。方法选择新疆医科大学第一附属医院2002年9月至2012年9月食管癌术后发生呼吸衰竭的患者49例(呼吸衰竭组),并随机抽取同期食管癌术后未发生呼吸衰竭患者98例作为对照组,分析食管癌术后发生呼吸衰竭的危险因素。结果单因素分析结果表明食管癌术后发生呼吸衰竭与下列因素有关:最大通气量(MVV)、1 s用力呼气量(FEV1)、最大呼气流量、FEV1/用力肺活量、吸烟指数、手术时间、机械通气时间、术前并发呼吸系统疾病、吻合口位置、术后其他并发症。Logistic回归分析表明:FEV1≤1.5 L、MVV实测值/预测值≤50%、术后其他并发症及手术时间≥3 h为其独立危险因素。结论全面评估及改善术前肺功能,提高手术技巧,尽量减少手术时间,术后严密观察病情减少其他并发症的发生是降低食管癌术后呼吸衰竭的重要因素。

Risk factors for esophageal postoperative respiratory failure

Objective To explore the risk factors for postoperative respiratory failure(RF)in patients undergoing esophagectomy.Methods Forty-nine patients with RF after esophagectomy in the First Affiliated Hospital of Xinjiang Medical University were selected from Sep.2002 to Sep.2012 as RF group,and 98 patients without postoperative RF were selected randomly during the same period as control group.The risk factors for esophageal postoperative respiratory failure were analyzed.Results Univariate analysis results showed that the following factors were related to the postoperative RF after esophagectomy:maximum voluntary ventilation(MVV),forced expiratory volume in one second(FEV1),peak expiratory flow,FEV1/forced vital capacity(FVC),smoking index,operation time,mechanicalventilation time,preoperative respiratory disease,anastomotic location and other postoperative complications.Logistic regression analysis showed that FEV1≤1.5 L,MVV actual value/predicted value≤50%,other postoperative complications and operation time≥3 hours were the independent risk factors.Conclusion Comprehensive assessment and improvement of preoperative pulmonary function,improving surgical techniques,shortening operation time as far as possible,postoperative strict observation to reduce the incidence of other complications were the important factors in reducing the postoperative RF of patients undergoing esophagectomy.