慢性阻塞性肺疾病患者非小细胞肺癌肺切除术后围手术期吸入性糖皮质激素的使用与术后呼吸并发症之间的关系
The relationship between perioperative administration of inhaled corticosteroid and postoperative respiratory complications after pulmonary resection for non-small-cell lung cancer in patients with chronic obstructive pulmonary disease.
作者信息
Yamanashi Keiji, Marumo Satoshi, Shoji Tsuyoshi, Fukui Takamasa, Sumitomo Ryota, Otake Yosuke, Sakuramoto Minoru, Fukui Motonari, Huang Cheng-Long
机构信息
Respiratory Disease Center, Tazuke Kofukai Foundation, Medical Research Institute, Kitano Hospital, 2-4-20 Ohgimachi, Kita-ku, Osaka, 530-8480, Japan.
Department of Thoracic Surgery, Japanese Red Cross Otsu Hospital, Shiga, Japan.
出版信息
Gen Thorac Cardiovasc Surg. 2015 Dec;63(12):652-9. doi: 10.1007/s11748-015-0593-0. Epub 2015 Sep 29.
OBJECTIVES
Inhaled corticosteroid (ICS) treatment has been shown to increase the risk of respiratory complications in patients with stable chronic obstructive pulmonary disease (COPD). However, the effects of perioperative ICS treatment on postoperative respiratory complications after lung cancer surgery have not been elucidated. The aim of this study was to investigate whether perioperative ICS treatment would increase the risk of postoperative respiratory complications after lung cancer surgery in patients with COPD.
METHODS
We retrospectively analyzed 174 consecutive COPD patients with non-small-cell lung cancer (NSCLC) who underwent lobectomy or segmentectomy between January 2007 and December 2014. Subjects were grouped based on whether or not they were administered perioperative ICS treatment. Postoperative cardiopulmonary complications were compared between the groups.
RESULTS
There were no statistically significant differences in the incidence of postoperative respiratory complications (P = 0.573) between the perioperative ICS treatment group (n = 16) and the control group (n = 158). Perioperative ICS treatment was not significantly associated with postoperative respiratory complications in the univariate or multivariate analysis (odds ratio [OR] = 0.553, 95% confidence interval [CI] = 0.069-4.452, P = 0.578; OR = 0.635, 95% CI = 0.065-6.158, P = 0.695, respectively). Kaplan-Meier analysis showed that there were no statistically significant differences in the postoperative respiratory complications-free durations between the groups (P = 0.566), even after propensity score matching (P = 0.551).
CONCLUSION
There was no relationship between perioperative ICS administration and the incidences of postoperative respiratory complications after surgical resection for NSCLC in COPD patients.
目的
吸入性糖皮质激素（ICS）治疗已被证明会增加稳定期慢性阻塞性肺疾病（COPD）患者发生呼吸并发症的风险。然而，围手术期ICS治疗对肺癌手术后术后呼吸并发症的影响尚未阐明。本研究的目的是调查围手术期ICS治疗是否会增加COPD患者肺癌手术后术后呼吸并发症的风险。
方法
我们回顾性分析了2007年1月至2014年12月期间连续接受肺叶切除术或肺段切除术的174例非小细胞肺癌（NSCLC）合并COPD患者。根据是否接受围手术期ICS治疗对受试者进行分组。比较两组术后心肺并发症情况。
结果
围手术期ICS治疗组（n = 16）和对照组（n = 158）术后呼吸并发症发生率无统计学显著差异（P = 0.573）。在单因素或多因素分析中，围手术期ICS治疗与术后呼吸并发症无显著相关性（优势比[OR] = 0.553，95%置信区间[CI] = 0.069 - 4.452，P = 0.578；OR = 0.635，95% CI = 0.065 - 6.158，P = 0.695）。Kaplan - Meier分析显示，两组术后无呼吸并发症持续时间无统计学显著差异（P = 0.566），即使在倾向得分匹配后也是如此（P = 0.551）。
结论
COPD患者NSCLC手术切除后，围手术期给予ICS与术后呼吸并发症的发生率之间无关联。
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