Sakai Rafael Luis, Abrão Graciela Maria Gera, Ayres José Franscisco Vasques, Vianna Pedro Thadeu Galvão, Carvalho Lídia Raquel de, Castiglia Yara Marcondes Machado
Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, São Paulo, Brazil.
Sao Paulo Med J. 2007 Nov 1;125(6):315-21. doi: 10.1590/s1516-31802007000600003.
The significant relationship between upper abdominal surgery and early (perioperative) pulmonary events was investigated among patients with preoperative pulmonary conditions undergoing general anesthesia.
Retrospective study for which data were obtained prospectively from 1999 to 2004, at a tertiary university hospital.
We retrospectively studied 3107 patients over 11 years old presenting American Society of Anesthesiologists (ASA) status I, II or III who underwent upper abdominal surgery under general anesthesia and were discharged to the recovery room. The preoperative conditions analyzed using logistic regression were: age, sex, ASA physical status, congestive heart failure, asthma, chronic obstructive pulmonary disease (COPD), respiratory failure and smoking. The outcomes or dependent variables included intraoperative and postoperative events: bronchospasm, hypoxemia, hypercapnia, prolonged intubation and airway secretion.
Among these patients (1500 males, 1607 females, mean age 48 years, 1088 ASA I, 1402 ASA II and 617 ASA III), there were 80 congestive heart failures, 82 asthmatics, 122 with COPD, 21 respiratory failures and 428 smokers. Logistic regression analysis showed that female sex (p < 0.001), age over 70 years (p < 0.01), smoking (p < 0.001) and COPD (p < 0.02) significantly influenced pulmonary event development, particularly hypoxemia and bronchospasm, at both times but not in the same patients. Asthma and congestive heart failure cases did not present pulmonary events in the recovery room.
In upper abdominal surgery under general anesthesia, female sex, age over 70, smoking and COPD were independent risk factors for intra and postoperative pulmonary events.
在接受全身麻醉且术前存在肺部疾病的患者中，研究上腹部手术与早期（围手术期）肺部事件之间的显著关系。
回顾性研究，于1999年至2004年在一所三级大学医院前瞻性收集数据。
我们回顾性研究了3107例11岁以上、美国麻醉医师协会（ASA）分级为I、II或III级、接受全身麻醉下上腹部手术并被送入恢复室的患者。使用逻辑回归分析的术前情况包括：年龄、性别、ASA身体状况、充血性心力衰竭、哮喘、慢性阻塞性肺疾病（COPD）、呼吸衰竭和吸烟。结局或因变量包括术中和术后事件：支气管痉挛、低氧血症、高碳酸血症、插管时间延长和气道分泌物。
在这些患者中（1500例男性，1607例女性，平均年龄48岁，1088例ASA I级，1402例ASA II级和617例ASA III级），有80例充血性心力衰竭患者，82例哮喘患者，122例COPD患者，21例呼吸衰竭患者和428例吸烟者。逻辑回归分析表明，女性（p < 0.001）、70岁以上（p < 0.01）、吸烟（p < 0.001）和COPD（p < 0.02）在两个时间段均对肺部事件的发生有显著影响，尤其是低氧血症和支气管痉挛，但并非同一患者。哮喘和充血性心力衰竭患者在恢复室未出现肺部事件。
在全身麻醉下的上腹部手术中，女性、70岁以上、吸烟和COPD是术中和术后肺部事件的独立危险因素。
