外科手术后早期低氧血症的临床分析

目的 探讨术后早期的低氧血症发生的高危因素,预防术后早期低氧血症的发生.方法 将2005年7月至2007年6月进入上海交通大学医学院附属仁济医院外科监护室于手术后24 h内发生低氧血症的患者作为病例组,按1:2比例随机抽取同时期进入外科监护室未发生低氧血症的手术患者作为对照组.分析病例组患者的手术类型以及引起术后早期低氧血症的直接原因.筛选出高危因素后在两组间进行单因素分析和Logistic多元回归分析.结果 病例组患者以接受胸部手术(33.78%)和上腹部手术(24.32%)为主.术后早期引起低氧血症的直接原因包括:肺部原发病加重(17.57%)、胸部手术并发症(24.32%)、围手术期处理不当(21.62%)、其他基础疾病(18.92%)等.单因素分析发现:大量吸烟史、术前合并肺部原发病、危重患者、合并胸部手术并发症、大量输液以及呼吸支持不足等因素与术后低氧血症密切相关.多因素分析结果表明,术前合并肺部原发病、危重患者、合并胸部手术并发症以及呼吸支持不足的患者术后低氧血症发生的风险显著增加(P<0.05).结论 术后早期低氧血症与大量吸烟、肺部及其他系统危重疾病、胸部手术并发症、输液过多以及呼吸支持不足等因素密切相关,必须采取相应措施防止术后早期低氧血症的发生.

Clinical analysis of early postoperative hypoxemia

Objective To study high risk factors of early postoperative hypoxemia and its prevention. Methods Patients admitted to SICU suffering from postoperative hypoxemia in 24 h during recent 2 years were taken as case group. Those who did not suffering from postoperative hypoxemia during the same period drawn by proportion of 1:2 randomly were taken as control group. The surgical operation categories and directive cause of hypoxemia were analyzed in case group. Then the high risk factors were deduced and were investig ated with single factor analysis and Logistie multiple regression analysis. Results Surgical operation categories in case group were mainly thoracic operation (33.78%) and upper abdominal surgeries (24.32%). Directive cause of hypoxemia included the aggravation of pulmonary primary disease(17.57%), the complication of thoracic operation (24.32%), improper disposal of perioperative management (18.92%) and so on. Analysing factor indicated that a long history of smoking,pulmonary primary disease,critically ill patients, complication of thoracic operation, a great quantity transfusion and insufficient respiratory supporting were concerned with early postoperative hypoxemia. Logistic multiple regression found that pulmonary primary disease, critically ill patients, complication of thoracic operation and insufficient respiratory supporting could increase the risk of hypoxemia remarkably (P<0.05). Conclusions Pulmonary primary disease, critically ill patients, complication of thoraeie operation and insufficient respiratory supporting are tightly concerned with early postoperative hypoxemia. Corresponding measures should be taken for its prevention.