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肺切除术术后早期死亡率和发病率的危险因素:再评价。

Risk factors for early mortality and morbidity after pneumonectomy: a reappraisal.

机构信息

Service de Chirurgie Thoracique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.

出版信息

Ann Thorac Surg. 2009 Dec;88(6):1737-43. doi: 10.1016/j.athoracsur.2009.07.016.

Abstract

BACKGROUND

Pneumonectomy remains a high-risk procedure. Comprehensive patient selection should be based on analysis of proven risk factors.

METHODS

The records of 323 pneumonectomy patients were retrospectively reviewed. Multiple demographic data were collected. End points were operative mortality at 30 and at 90 days, major procedurally related complications, and cardiovascular events. Univariate and multivariate statistical analyses were performed.

RESULTS

Smoking habits, chronic obstructive pulmonary disease (COPD) status, induction chemotherapy status, diabetes, and obesity had no statistical influence on short-term outcomes. After right pneumonectomy, 30-day mortality (p = 0.045) and the incidence of bronchopleural fistulas (p = 0.009) were increased. Multivariate analysis for postoperative bronchopleural fistulas discovered that right pneumonectomies are the sole risk factor (p = 0.015). Univariate analysis for postoperative atrial fibrillation showed that male gender, age 70 and older, hypertension, and dyslipidemia are risk factors. Multivariate analysis found no definite risk factor. Patients with coronary artery disease had more postoperative cardiovascular events (p = 0.003). Among patients free of coronary artery disease, COPD led to an increased 90-day mortality rate (p = 0.028).

CONCLUSIONS

Patients with right pneumonectomies are at increased risk. Postoperative cardiovascular events are more frequent in coronary artery disease patients. COPD is a risk factor in patients free of coronary disease.

摘要

背景

肺切除术仍然是一种高风险的手术。全面的患者选择应基于对已证实的风险因素的分析。

方法

回顾性分析了 323 例肺切除术患者的记录。收集了多个人口统计学数据。终点为 30 天和 90 天的手术死亡率、主要与程序相关的并发症和心血管事件。进行了单变量和多变量统计分析。

结果

吸烟习惯、慢性阻塞性肺疾病(COPD)状态、诱导化疗状态、糖尿病和肥胖对短期结果没有统计学影响。右肺切除术后,30 天死亡率(p=0.045)和支气管胸膜瘘发生率(p=0.009)增加。术后支气管胸膜瘘的多变量分析发现,右肺切除术是唯一的危险因素(p=0.015)。术后心房颤动的单变量分析显示,男性、年龄 70 岁及以上、高血压和血脂异常是危险因素。多变量分析未发现明确的危险因素。患有冠状动脉疾病的患者术后发生心血管事件的风险更高(p=0.003)。在没有冠状动脉疾病的患者中,COPD 导致 90 天死亡率增加(p=0.028)。

结论

右肺切除术患者的风险增加。患有冠状动脉疾病的患者术后心血管事件更为频繁。COPD 是无冠状动脉疾病患者的危险因素。

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