Silva Denise Rossato, Gazzana Marcelo Basso, Knorst Marli Maria
Hospital de Clínicas de Porto Alegre, RS, Brazil.
Rev Assoc Med Bras (1992). 2010 Sep-Oct;56(5):551-7. doi: 10.1590/s0104-42302010000500016.
To assess the relationship of clinical data and the results of preoperative pulmonary functional evaluation with postoperative pulmonary complications.
We conducted a retrospective cohort study with patients who underwent pulmonary functional evaluation over a period of 5 years. We analyzed clinical, demographic and spirometric data, surgical procedures performed and postoperative pulmonary complications.
We analyzed the medical records of 521 patients. Mean age was 59.5 ± 14 years, 65.8% were male, and 93.4% were white. Mean FEV1 was 76.6 ± 24.6% of predicted. There were clinical comorbidities in 73.5% of all cases (COPD in 29.8%). The most common surgical sites were thorax (n = 122; 23.4%) and upper abdomen (n = 117; 22.5%). Postoperative pulmonary complications occurred in 99 patients (19.0%), with respiratory failure being the most common (4.6%). Forty-three (8.3%) patients died. Rates of pulmonary complications were higher after thoracic (28.9%), cardiac (28%) and upper abdomen surgery (24.3%) (p ≤ 0.0001). Most patients (66.7%) with pulmonary complications were classified as ASA III or IV (p<0.01), and in 70.2% of operations, time on anesthesia was > 3.5 hours (p ≤ 0.0001). The difference in median length of hospital stay between patients with and without pulmonary complications was statistically significant (23.5 [15.8-34] days vs. 10 [6-18] days; p<0.001). Patients who had never smoked had fewer complications than those with current or past smoking history (p=0.04). We did not detect significant associations between postoperative pulmonary complications and presence of COPD, FEV1 or body mass index (p>0.05).
The most important factors associated with postoperative pulmonary complications were surgical site, time of anesthesia, and ASA classification.
评估临床数据及术前肺功能评估结果与术后肺部并发症之间的关系。
我们对5年内接受肺功能评估的患者进行了一项回顾性队列研究。我们分析了临床、人口统计学和肺量计数据、所实施的手术操作以及术后肺部并发症。
我们分析了521例患者的病历。平均年龄为59.5±14岁，65.8%为男性，93.4%为白人。平均第一秒用力呼气容积（FEV1）为预测值的76.6±24.6%。所有病例中有73.5%存在临床合并症（慢性阻塞性肺疾病（COPD）占29.8%）。最常见的手术部位是胸部（n = 122；23.4%）和上腹部（n = 117；22.5%）。99例患者（19.0%）发生了术后肺部并发症，其中呼吸衰竭最为常见（4.6%）。43例（8.3%）患者死亡。胸部（28.9%）、心脏（28%）和上腹部手术（24.3%）后肺部并发症发生率较高（p≤0.0001）。大多数发生肺部并发症的患者（66.7%）被归类为美国麻醉医师协会（ASA）Ⅲ级或Ⅳ级（p<0.01），并且在70.2%的手术中，麻醉时间>3.5小时（p≤0.0001）。有肺部并发症和无肺部并发症患者的中位住院时间差异具有统计学意义（23.5[15.8 - 34]天 vs. 10[6 - 18]天；p<0.001）。从不吸烟的患者比有当前或既往吸烟史的患者并发症更少（p = 0.04）。我们未发现术后肺部并发症与COPD的存在、FEV1或体重指数之间存在显著关联（p>0.05）。
与术后肺部并发症相关的最重要因素是手术部位、麻醉时间和ASA分级。
