肺切除术后急性呼吸衰竭高危因素分析及预防

目的:探讨对肺切除术后发生急性呼吸衰竭(呼衰)高危因素分析及预防。方法:分析46例肺肿瘤术后发生呼衰患者的年龄,术前肺功能及合并症、手术方法、手术当日静脉输液量、术后并发症及呼衰发生时间与同期未发生术后呼衰患者对比,找出围手术期可能导致呼衰的高危因素。结果:术前肺活量占预计值的百分率(VC%),第一秒用力呼气容积占用力肺活量的百分率(FEV1%),最大通气量占预计值的百分率(MVV%),气速指数均显著低于对照组(P<0.01或<0.05)。残气容积、肺总量的比值(RV/TLC)显著高于对照组(P<0.05)。呼衰组术日静脉晶体入量和输血量及术后胸腔引流量显著高于对照组(P<0.01或<0.001)。部分肺切除术后的呼衰发生可能性低于全肺切除(P<0.05)。结论:年龄>65岁,长期吸烟,术前慢性呼吸系统疾病及心肺功能差,全肺切除及术后出现胸内并发症,围手术期输液量过多过快是肺切除术后发生急性呼衰的高危因素。

Analysis of Risky Factors of Postoperative Respiratory Failure in Patients with Lung Neoplasm

Objective:To prevent the postoperative acute respiratory failure.Methods:An-alyzing46patients with postoperative respiratory failure in age,preoperative lung function pre and post-operative complications and the time of postoperative respiratory failure occur.Compare with same period patients without postoperative respiratory failure.Results:Preoperative VC%,FEV 1 %,MVV%in respiratory failure group were all significantly lower than those in control group(P<0.01or0.05).Preoperative RV/TLC in respiratory failure group was significantly more than those in control group(P<0.05).The perioperative intravenous perfussion and postoperative chest drainage in respiratory failure group were significantly more than those in control group(P<0.01or0.001).The odds of respiratory failure were much lower in part pneumonectomy group than fully pneumonectomy.Conclusion:Risky factors of postoperative respiratory failure were ages more than65,fat and over,heavy smoking,pre and post-operative complications perioperative intra-venous perfussion.