Filardo Flavia De Almeida, Faresin Sonia Maria, Fernandes Ana Luisa Godoy
disciplina de Pneumologia, Universidade Federal de São Paulo, Brazil.
Rev Assoc Med Bras (1992). 2002 Jul-Sep;48(3):209-16. doi: 10.1590/s0104-42302002000300032.
To validate a previous prognostic index (Pereira et al.) to postoperative pulmonary complication in elective upper abdominal surgery, and observe the risk factor for mortality in this population.
283 patients were followed from pre to postoperative period. They were followed in a protocol including a clinical questionnaire, physical examination, thoracic radiogram and spirometry at pre operative period. The main variables measured were: clinical and functional subjects characteristics at pre operative, type of surgery, duration of surgery, time spent in intensive care unit and hospitalization and the occurrence of pulmonary complication.
69 patients had pulmonary complications (24.4%), in 87 events registered. These occurred because some patients had more than one complication. Pneumonia was the most freqüent event 34% (30/87) followed by atelectasis 24% (21/87), bronchoconstriction 17% (15/87), acute respiratory failure 13% (11/87), prolonged mechanical ventilation 9% (8/87) and bronchial infection 2% (2/87). The multiple logistic regression (MLR) showed the association between age above 56 years old (p = 0.0039); DS > 210 (p = 0.0044) and previous chronic pneumopathy (p = 0.0257) and postoperative pulmonary complication. The frequency of postoperative pulmonary complication observed in each categorical classis based on previous index (Pereira equation) did not differ statistically from the prognostic rate calculated, showing the validity of the prognostic index. When FEV1/FVC was included in MLR, the patients with VEF1/FVC<70% and DS> 210 minutes showed a statistically lower number of pulmonary postoperative compared with estimated by the previous Pereira index. The mortality analyses showed significant association with comorbidity, number of days in care unit and postoperative pulmonary complication, however in the MLR only postoperative pulmonary complication had a significant association with death (p = 0.003).
The index based on Pereira equation is valid to estimate the prognosis of postoperative pulmonary complication after elective upper abdominal surgery. Age higher 56 years old, duration of surgery more than 210 minutes and pneumopathy are important markers of postoperative pulmonary complication. The only significant marker for mortality was the post operative pulmonary complication.
验证先前的预后指数（佩雷拉等人）在择期上腹部手术后肺部并发症中的有效性，并观察该人群的死亡风险因素。
对283例患者进行术前至术后的随访。按照方案进行随访，包括术前的临床问卷、体格检查、胸部X光片和肺活量测定。测量的主要变量包括：术前的临床和功能特征、手术类型、手术持续时间、在重症监护病房和住院的时间以及肺部并发症的发生情况。
69例患者发生肺部并发症（24.4%），共记录到87起事件。这是因为一些患者有不止一种并发症。肺炎是最常见的事件，占34%（30/87），其次是肺不张，占24%（21/87），支气管收缩占17%（15/87），急性呼吸衰竭占13%（11/87），机械通气延长占9%（8/87），支气管感染占2%（2/87）。多元逻辑回归（MLR）显示，56岁以上（p = 0.0039）；DS>210（p = 0.0044）以及既往慢性肺病（p = 0.0257）与术后肺部并发症之间存在关联。基于先前指数（佩雷拉方程）在每个分类类别中观察到的术后肺部并发症发生率与计算出的预后率在统计学上没有差异，表明预后指数的有效性。当将FEV1/FVC纳入MLR时，与先前佩雷拉指数估计的相比，VEF1/FVC<70%且DS>210分钟的患者术后肺部并发症的数量在统计学上较低。死亡率分析显示与合并症、在监护病房的天数和术后肺部并发症有显著关联，然而在MLR中只有术后肺部并发症与死亡有显著关联（p = 0.003）。
基于佩雷拉方程的指数对于估计择期上腹部手术后肺部并发症的预后是有效的。56岁以上、手术持续时间超过210分钟和肺病是术后肺部并发症的重要标志。唯一显著的死亡标志是术后肺部并发症。
