Axelsson Tomas Andri, Sigurdsson Martin Ingi, Alexandersson Asgeir, Thorsteinsson Hunbogi, Klemenzson Gudmundur, Jonsson Steinn, Gudbjartsson Tomas
Department of Cadiothoracic Surgery, University of Iceland, Iceland.
Laeknabladid. 2012 May;98(5):271-5. doi: 10.17992/lbl.2012.05.431.
Following resection for non-small cell lung cancer (NSCLC), patients are usually admitted to the post-anesthesia care unit (PACU)for a few hours before admission to a general ward (GW). However, some patients need ICU-admission, either immediately post-surgery or from the PACU or GW. The aim of this study was to investigate the indications and risk factors for ICU-admission.
A retrospective study of 252 patients who underwent lobectomy, wedge resection or segmentectomy for NSCLC in Iceland during 2001-2010. Data was retrieved from medical records and patients admitted to the ICU compared to patients not admitted.
Altogether 21 patients (8%) were admitted to the ICU, median length-of-stay being one day (range 1-68). In 11 cases (52%) the reasons for admission were intraoperative problems, usually hypotension or excessive bleeding. Ten patients were admitted from the GW (n=4) or PACU (n=6), due to hypotension (n=4), heart and/or respiratory failure (n=4) and reoperation for bleeding (n=2). There were three ICU-readmissions. Patients admitted to the ICU were six years older (p=0.004) and more often had chronic obstructive pulmonary disease and/or coronary artery disease. Tumor size, pTNM-stage, length of operation and the ratio of patients receiving TEA (thoracic epidural anaesthesia) were similar between groups. Over two-thirds of the ICU-patients had minor complications and around half had major complications, compared to 30% and 4%, respectively, for controls.
ICU-admissions are infrequent following non-pneumonectomy lung resections for NSCLC, these patients being older with cardiopulmonary comorbidities. In half of the cases, admission to the ICU directly follows surgery and ICU-readmissions are few.
非小细胞肺癌（NSCLC）切除术后，患者通常会在麻醉后护理单元（PACU）停留数小时，然后再转入普通病房（GW）。然而，一些患者术后需要立即入住重症监护病房（ICU），或者从PACU或GW转入。本研究旨在调查入住ICU的指征和危险因素。
对2001年至2010年期间在冰岛接受NSCLC肺叶切除术、楔形切除术或肺段切除术的252例患者进行回顾性研究。数据从病历中获取，将入住ICU的患者与未入住的患者进行比较。
共有21例患者（8%）入住ICU，中位住院时间为1天（范围1 - 68天）。11例（52%）患者入住ICU的原因是术中出现问题，通常是低血压或出血过多。10例患者从GW（n = 4）或PACU（n = 6）转入ICU，原因包括低血压（n = 4）、心脏和/或呼吸衰竭（n = 4）以及因出血再次手术（n = 2）。有3例患者再次入住ICU。入住ICU的患者年龄比未入住者大6岁（p = 0.004），且更常患有慢性阻塞性肺疾病和/或冠状动脉疾病。两组患者的肿瘤大小、pTNM分期、手术时长以及接受胸段硬膜外麻醉（TEA）的患者比例相似。与对照组分别为30%和4%相比，超过三分之二的ICU患者有轻微并发症，约一半有严重并发症。
NSCLC非全肺切除术后入住ICU的情况并不常见，这些患者年龄较大且伴有心肺合并症。半数情况下，患者直接在术后入住ICU，再次入住ICU的情况较少。
