Cleveland, Ohio From the Departments of Surgery and Anesthesiology, University Hospitals Case Medical Center.
Plast Reconstr Surg. 2012 Oct;130(4):836-841. doi: 10.1097/PRS.0b013e318262f160.
Patients undergoing abdominal wall reconstruction are at risk of developing major postoperative respiratory complications. The authors attempted to identify factors predictive of respiratory complications following abdominal wall reconstruction.
All patients who underwent complex abdominal wall reconstruction over a 2-year period were reviewed. The primary endpoint studied was severe respiratory complication, defined as respiratory insufficiency requiring intubation or transfer to a higher level of care.
Sixty patients underwent complex abdominal wall reconstruction during the study period. The incidence of respiratory complications was 20 percent. Factors predictive of postoperative respiratory complication included age (p = 0.05), American Society of Anesthesiologists score (p = 0.04), and hernia defect size (p = 0.01). In addition, patients who developed respiratory complications were more likely to have had a greater change in plateau pressure (5.8 versus 2.3 cmH(2)O; p = 0.01). The greater the change in plateau pressure, the greater the risk of developing a respiratory complication: for a change in plateau pressure greater than or equal to 6 cmH(2)O, the odds ratio was 8.67; for a change in plateau pressure greater than or equal to 9 cmH(2)O, the odds ratio was 11.5.
Respiratory complications following abdominal wall reconstruction can be serious and are associated with prolonged hospitalizations. Patients with an increase in their plateau pressure of greater than 6 cmH(2)O are at an increased risk of severe postoperative respiratory complications.
接受腹壁重建的患者有发生重大术后呼吸并发症的风险。作者试图确定预测腹壁重建后呼吸并发症的因素。
回顾了在 2 年期间接受复杂腹壁重建的所有患者。研究的主要终点是严重呼吸并发症，定义为需要插管或转至更高水平护理的呼吸功能不全。
在研究期间，有 60 名患者接受了复杂腹壁重建。呼吸并发症的发生率为 20%。预测术后呼吸并发症的因素包括年龄（p=0.05）、美国麻醉医师协会评分（p=0.04）和疝缺陷大小（p=0.01）。此外，发生呼吸并发症的患者的平台压变化更可能更大（5.8 与 2.3cmH2O；p=0.01）。平台压变化越大，发生呼吸并发症的风险越高：平台压变化大于或等于 6cmH2O 的比值比为 8.67；平台压变化大于或等于 9cmH2O 的比值比为 11.5。
腹壁重建后发生的呼吸并发症可能很严重，并与住院时间延长有关。平台压增加大于 6cmH2O 的患者发生严重术后呼吸并发症的风险增加。
