Barrera Rafael, Shi Weiji, Amar David, Thaler Howard T, Gabovich Natalie, Bains Manjit S, White Dorothy A
Department of Anesthesiology and Critical Care Medicine, Pulmonary Section, Weill Graduate School of Medical Sciences, Memorial Sloan-Kettering Hospital, 1275 York Ave, New York, NY 10021, USA.
Chest. 2005 Jun;127(6):1977-83. doi: 10.1378/chest.127.6.1977.
The benefit of smoking cessation just prior to surgery in preventing postoperative pulmonary complications has not been proven. Some studies actually show a paradoxical increase in complications in those quitting smoking only a few weeks or days prior to surgery. We studied the effect of smoking and the timing of smoking cessation on postoperative pulmonary complications in patients undergoing thoracotomy.
Prospective study conducted in a tertiary care cancer center in 300 consecutive patients with primary lung cancer or metastatic cancer to the lung who were undergoing anatomical lung resection.
The groups studied were nonsmokers (21%), past quitters of > 2 months duration (62%), recent quitters of < 2 months duration (13%), and ongoing smokers (4%). Overall pulmonary complications occurred in 8%, 19%, 23%, and 23% of these groups, respectively, with a significant difference between nonsmokers and all smokers (p = 0.03) but no difference among the subgroups of smokers (p = 0.76). The risk of pneumonia was significantly lower in nonsmokers (3%) compared to all smokers (average, 11%; p < 0.05), with no difference detected among subgroups of smokers (p = 0.17). Comparing recent quitters and ongoing smokers, no differences in pulmonary complications or pneumonia were found (p = 0.67). Independent risk factors for pulmonary complications were a lower diffusing capacity of the lung for carbon monoxide (Dlco) [odds ratio [ OR] per 10% decrement, 1.41; 95% confidence interval [ CI], 1.17 to 1.70; p = 0.01) and primary lung cancer rather than metastatic disease (OR, 3.94; 95% CI, 1.34 to 11.59; p = 0.003). Among smokers, a lower Dlco percent predicted (OR per 10% decrement, 1.42; 95% CI, 1.16 to 1.75; p = 0.008) and a smoking history of > 60 pack-years (OR, 2.54; 95% CI, 1.28 to 5.04; p = 0.0008) were independently associated with overall pulmonary complications.
In patients undergoing thoracotomy for primary or secondary lung tumors, there is no evidence of a paradoxical increase in pulmonary complications among those who quit smoking within 2 months of undergoing surgery. Smoking cessation can safely be encouraged prior to surgery.
术前即刻戒烟对预防术后肺部并发症的益处尚未得到证实。一些研究实际上显示，在术前仅几周或几天戒烟的患者中，并发症反而出现了反常增加。我们研究了吸烟及戒烟时间对接受开胸手术患者术后肺部并发症的影响。
在一家三级医疗癌症中心进行的前瞻性研究，连续纳入300例接受解剖性肺切除术的原发性肺癌或肺转移癌患者。
所研究的组包括非吸烟者（21%）、戒烟超过2个月的既往戒烟者（62%）、戒烟时间不足2个月的近期戒烟者（13%）和持续吸烟者（4%）。这些组中总体肺部并发症的发生率分别为8%、19%、23%和23%，非吸烟者与所有吸烟者之间存在显著差异（p = 0.03），但吸烟者亚组之间无差异（p = 0.76）。与所有吸烟者（平均11%）相比，非吸烟者的肺炎风险显著更低（3%）（p < 0.05），吸烟者亚组之间未检测到差异（p = 0.17）。比较近期戒烟者和持续吸烟者，肺部并发症或肺炎方面未发现差异（p = 0.67）。肺部并发症的独立危险因素是肺一氧化碳弥散量（Dlco）降低[每降低10%的比值比（OR）为1.41；95%置信区间（CI）为1.17至1.70；p = 0.01]以及原发性肺癌而非转移性疾病（OR为3.94；95% CI为1.34至11.59；p = 0.003）。在吸烟者中，较低的Dlco百分比预测（每降低10%的OR为1.42；95% CI为1.16至1.75；p = 0.008）以及吸烟史超过60包年（OR为2.54；95% CI为1.28至5.04；p = 0.0008）与总体肺部并发症独立相关。
在接受原发性或继发性肺肿瘤开胸手术的患者中，没有证据表明在手术前2个月内戒烟的患者肺部并发症会反常增加。术前可以安全地鼓励患者戒烟。
