Incidence of and risk factors for pulmonary complications after nonthoracic surgery
Incidence of and risk factors for pulmonary complications after nonthoracic surgery
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DOI：
10.1164/rccm.200408-1069oc
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发表时间：
2005-03-01
影响因子：
24.7
通讯作者：
Jacka, M
中科院分区：
文献类型：
--
作者：
McAlister, FA;Bertsch, K;Jacka, M
术后肺部并发症的预测是一个研究不足的领域。我们进行了一项前瞻性队列研究（由对围手术期变量不知情的研究者确定术后肺部并发症），以确定择期非胸外科手术后肺部并发症的危险因素。在大学医院入院前门诊就诊的连续 1,055 名患者（平均年龄 55 岁，50% 男性，15% 有阻塞性气道疾病史）中，28 名（2.7%）在手术后 7 天内出现术后肺部并发症：13 名患者出现需要通气支持的呼吸衰竭，9 名患者出现肺炎，5 名患者出现需要支气管镜干预的肺不张，以及 1 名需要干预的气胸。手术后 7 天内出现肺部并发症的患者的平均住院时间显着延长：27.9 天与 4.5 天，p = 0.006。双变量分析显示，八个变量与肺部并发症具有统计学显着相关性。多变量分析显示，四种因素与肺部并发症风险增加独立相关：年龄（年龄大于或等于 65 岁的比值比 [OR] 5.9，p < 0.001）、咳嗽试验阳性（OR 3.8，P = 0.01）、围手术期鼻胃管（OR 7.7，p < 0.001）和麻醉持续时间（手术持续时间至少为 OR 3.3） 2.5 小时，p = 0.008）。因此，一些围手术期因素预测择期非胸外科手术后肺部并发症的风险增加。
The prediction of postoperative pulmonary complications is an underinvestigated field. We conducted a prospective cohort study (with postoperative pulmonary complications ascertained by an investigator blinded to perioperative variables) to determine the risk factors for pulmonary complications after elective nonthoracic surgery. Of 1,055 consecutive patients attending the Pre-Admission Clinic of a university hospital (mean age 55 years, 50% men, 15% with history of obstructive airways disease), 28 (2.7%) suffered a postoperative pulmonary complication within 7 days of surgery: 13 patients developed respiratory failure requiring ventilatory support, 9 pneumonia, 5 atelectasis requiring bronchoscopic intervention, and I pneumothorax requiring intervention. Mean lengths of stay were substantially prolonged for those patients who developed pulmonary complications within 7 days of surgery: 27.9 days versus 4.5 days, p = 0.006. Eight variables were statistically significantly associated with pulmonary complications on bivariate analyses. Multivariate analyses revealed that four were independently associated with increased risk of pulmonary complications: age (odds ratio [OR] 5.9 for age greater than or equal to 65 years, p < 0.001), positive cough test (OR 3.8, P = 0.01), perioperative nasogastric tube (OR 7.7, p < 0.001), and duration of anesthesia (OR 3.3 for operations lasting at least 2.5 hours, p = 0.008). Thus, several perioperative factors predict an increased risk for pulmonary complications after elective nonthoracic surgery.