Patel R L, Townsend E R, Fountain S W
Department of Thoracic Surgery, Harefield Hospital, United Kingdom.
Ann Thorac Surg. 1992 Jul;54(1):84-8. doi: 10.1016/0003-4975(92)91145-y.
We have retrospectively reviewed hospital records of 197 consecutive patients undergoing pneumonectomy for neoplastic disease between 1985 and 1990 to identify predictors of outcome. Seventeen of the 197 patients died during their hospital stay (8.6%; 95% confidence intervals, 6.7% to 11.2%). The most significant predictors of in-hospital mortality were presence of coexisting medical conditions (p less than 0.001), respiratory function tests showing an obstructive picture with a forced expiratory volume in 1 second/forced vital capacity ratio of less than 0.55 (p less than 0.001), 24-hour fluid replacement of more than 3 L (p less than 0.05), postoperative pulmonary edema (p less than 0.001), respiratory tract infection with positive sputum culture (p less than 0.01), postoperative renal failure (p less than 0.001), and cardiac arrhythmias (p less than 0.001). There were 232 postoperative management, problems occurring in 197 patients. The most significant predictors of postoperative morbidity were continued cigarette smoking up to the time of operation (p less than 0.05), perioperative blood loss or more than 2 L (p less than 0.05), and infusion of more than 3 L of fluid in the first 24 hours (p less than 0.05). Although retrospective analyses must be interpreted with caution, this study has identified preoperative and perioperative factors associated with in-hospital morbidity and mortality after pneumonectomy.
我们回顾性分析了1985年至1990年间197例因肿瘤疾病接受肺切除术患者的医院记录，以确定预后的预测因素。197例患者中有17例在住院期间死亡（8.6%；95%置信区间为6.7%至11.2%）。住院死亡率最显著的预测因素是存在并存的内科疾病（p<0.001）、呼吸功能测试显示阻塞性表现且1秒用力呼气量/用力肺活量比值小于0.55（p<0.001）、24小时补液超过3L（p<0.05）、术后肺水肿（p<0.001）、痰培养阳性的呼吸道感染（p<0.01）、术后肾衰竭（p<0.001）和心律失常（p<0.001）。197例患者术后有232次管理问题发生。术后发病最显著的预测因素是直到手术时仍持续吸烟（p<0.05）、围手术期失血超过2L（p<0.05）以及在最初24小时内输液超过3L（p<0.05）。尽管回顾性分析必须谨慎解读，但本研究已确定了与肺切除术后住院发病率和死亡率相关的术前和围手术期因素。
