A study of the impact of long-term tobacco smoking on postoperative intensive care admission
A study of the impact of long-term tobacco smoking on postoperative intensive care admission
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DOI：
10.1046/j.1365-2044.2003.02788_2.x
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发表时间：
2003-01-01
期刊：
影响因子：
10.7
通讯作者：
Tonnesen, R
中科院分区：
文献类型：
--
作者：
Moller, AM;Pedersen, T;Tonnesen, R
吸烟是手术中肺部并发症以及各种术后肺部、心血管、感染和伤口相关并发症的危险因素。这些都可能导致计划外的术后重症监护入院。我们检验了一个假设，即在普通人群和骨科人群中，吸烟者比不吸烟者术后重症监护入院率高，术后并发症多。在6026例手术患者中评估了以下信息：年龄、性别和吸烟状况（包年）、心脏和肺部疾病史、美国麻醉医师协会（阿萨）体格分类、重症监护入院和术后并发症。2526例患者（46%）为吸烟者，但620例患者（10.3%）的吸烟状况未得到证实。319例患者（5.3%）需要术后重症监护。> 50包-年的患者比吸烟史小于或等于50包-年的患者和不吸烟者更常被送入重症监护室（p < 0.001）。吸烟史> 50包年的戒烟者与吸烟史> 50包年的吸烟者术后入院重症监护的风险相同。吸烟超过50包-年的重症监护患者有更高的慢性肺病（p < 0.005）和大量饮酒（p < 0.001）的发病率。吸烟者术后肺部并发症的发生率也较高（比值比= 3.91，p < 0.01）。吸烟史> 50包年的吸烟者死亡率为37%，非吸烟者为24%（优势比= 2.02，p = 0.08）。我们得出结论，长期吸烟（> 50包-年）具有较高的术后入住重症监护室的风险，并且吸烟量与术后入住重症监护室的风险之间似乎存在剂量关系。
Smoking is a risk factor for intra-operative pulmonary complications and a wide range of postoperative pulmonary, cardiovascular, infection and wound-related complications. These may all lead to unplanned postoperative intensive care admission. We tested the hypothesis that smokers have an increased incidence of postoperative intensive care admission and more postoperative complications than nonsmokers in a general and orthopaedic surgical population. The following information was assessed in 6026 surgical patients: age, sex and smoking status (pack-years), history of heart and lung disease, American Society of Anesthesiologists (ASA) physical classification, intensive care admission and postoperative complications. Two thousand five hundred and twenty-six (46%) were smokers but for 620 patients (10.3%) smoking status was not confirmed. Postoperative intensive care admission was required by 319 patients (5.3%). Patients with > 50 pack-years were admitted to the intensive care more frequently than were smokers with less than or equal to50 pack-years history and nonsmokers (p < 0.001). Ex-smokers with > 50 pack-years history had the same risk of postoperative admission to intensive care as smokers with > 50 pack-years history. Smokers admitted to intensive care with > 50 pack-years history had a higher incidence of chronic lung disease (p < 0.005) and heavy alcohol consumption (p < 0.001). These smokers also had a higher incidence of postoperative pulmonary complications (odds ratio = 3.91, p < 0.01). The mortality rate was 37% in smokers with > 50 pack-years history and 24% in nonsmokers (odds ratio = 2.02, p = 0.08). We conclude long-term tobacco smoking (> 50 pack-years) carries a higher risk of postoperative admission to intensive care, and there seems to be a dose relationship between the amount of tobacco consumed and the risk of postoperative intensive care admission.