肺切除术后急性呼吸衰竭的危险因素及护理对策

目的 探讨肺切除术后急性呼吸衰竭(ARF)的危险因素及护理策略。 方法 选择2015年4月—2016年2月间杭州师范大学附属医院收治的88例肺切除术患者，依据患者术后是否发生急性呼吸衰竭，将患者分为呼吸衰竭组和无呼吸衰竭组。收集2组患者的基本资料，包括:患者一般资料(性别、年龄、吸烟指数、心血管病史)、术前肺功能用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、最大通气量(MVV)、用力呼气量占用力肺活量比值(FEV1/FVC)]、手术方式(部分肺切除、全肺切除)、补液量(术中补液量、术后当天补液量)，采用单因素和Logistic回归分析对收集的数据资料进行分析。 结果 患者肺切除术后急性呼吸衰竭的发生率为31.8%。单因素和Logistic回归分析发现年龄、吸烟指数、心血管病史、FVC<1.8 L、FEV1<1.5 L、FEV1/FVC<70%、手术方式、术中补液量、术后当天补液量是肺切除患者术后发生急性呼吸衰竭的危险因素。 结论 肺切除患者术后易发生急性呼吸衰竭，年龄、吸烟指数、心血管病史、FVC<1.8 L、FEV1<1.5 L、FEV1/FVC<70%、手术方式、术中补液量、术后当天补液量是肺切除患者术后发生急性呼吸衰竭的危险因素，临床工作中要重视发生ARF的危险因素，做好预防和治疗工作。 

Risk factors and nursing strategies of acute respiratory failure after pneumonectomy

Objective To investigate the risk factors and nursing strategies of acute respiratory failure after pneumonectomy. Methods Eighty-eight patients with pneumonectomy from April,2015 to February,2016 were selected and divided into respiratory failure group and no respiratory failure group according to with or without acute respiratory failure after operation.The data of two groups were collected,including general information (gender,age,smoking index,cardiovascular history),preoperative pulmonary functionFVC,1 second expiratory volume(FEV1),max(MVV),forced expiratory volume(FEV1/FVC)],surgical methods(part lung resection,pneumonectomy),fluid volume(intraoperative fluid volume,postoperative day fluid volume),and were analyzed by univariate analysis and logistic regression analysis. Results The incidence of acute respiratory failure after pneumonectomy was 31.8%.Univariate analysis and logistic regression analysis results showed that age,smoking index,cardiovascular history,FVC<1.8 L,FEV1<1.5 L,FEV1/FVC<70%,operation mode,intraoperative fluid volume,postoperative fluid volume were postoperative risk factors for acute respiratory failure. Conclusion Postoperative acute respiratory failure easily occurred in patients with pneumonectomy,with age,smoking index,cardiovascular history,FVC<1.8 L,FEV1<1.5 L,FEV1/FVC<70%,operation mode,intraoperative fluid volume,postoperative fluid volume as postoperative risk factors for acute respiratory failure.The risk factors of ARF should be paid attention to in clinical work,and prevention and treatment should be carried out.