全身麻醉下全膝关节置换术后早期肺部并发症：一项使用CT扫描的前瞻性队列研究
Early Pulmonary Complications following Total Knee Arthroplasty under General Anesthesia: A Prospective Cohort Study Using CT Scan.
作者信息
Song Kai, Rong Zhen, Yang Xianfeng, Yao Yao, Shen Yeshuai, Shi Dongquan, Xu Zhihong, Chen Dongyang, Zheng Minghao, Jiang Qing
机构信息
Department of Sports Medicine and Adult Reconstruction, Drum Tower Hospital, Medical School of Nanjing University, Zhongshan Road 321, Nanjing, Jiangsu 210008, China; Joint Research Centre for Bone and Joint Disease, Model Animal Research Center (MARC), Nanjing University, Xuefu Road, Nanjing, Jiangsu 210032, China; Centre for Orthopaedic Research, School of Surgery, University of Western Australia, M508, 35 Stirling Highway, Crawley, WA 6009, Australia.
Department of Sports Medicine and Adult Reconstruction, Drum Tower Hospital, Medical School of Nanjing University, Zhongshan Road 321, Nanjing, Jiangsu 210008, China; Joint Research Centre for Bone and Joint Disease, Model Animal Research Center (MARC), Nanjing University, Xuefu Road, Nanjing, Jiangsu 210032, China.
出版信息
Biomed Res Int. 2016;2016:4062043. doi: 10.1155/2016/4062043. Epub 2016 Mar 16.
PURPOSE
Postoperative pulmonary complications (PPCs) are common after major surgeries. However, the number of studies regarding PPCs following total knee arthroplasty (TKA) is limited. The aim of this study was to determine the incidence of early PPCs following TKA by computed tomography (CT) scan and to identify associated risk factors.
METHODS
Patients, who were diagnosed with osteoarthritis or rheumatoid arthritis and underwent primary TKA at our institution, were included in this prospective cohort study. Patients received a standard procedure of TKA under general anesthesia. Chest CT scan was performed during 5-7 days postoperatively. Univariate analysis and multivariate logistic regression analysis were employed to identify the risk factors.
RESULTS
The total incidence of early PPCs following TKA was 45.9%. Rates of pneumonia, pleural effusion, and atelectasis were 14.4%, 38.7%, and 12.6%, respectively. Lower body mass index and perioperative blood transfusion were independent risk factors for PPCs as a whole and associated with atelectasis. Postoperative acute episode of hypoxemia increased the risk of pneumonia. Blood transfusion alone was related to pleural effusion.
CONCLUSIONS
The incidence of early PPCs following TKA was high. For patients with relevant risk factors, positive measures should be adopted to prevent PPCs.
目的
术后肺部并发症（PPCs）在大手术后很常见。然而，关于全膝关节置换术（TKA）后PPCs的研究数量有限。本研究的目的是通过计算机断层扫描（CT）确定TKA后早期PPCs的发生率，并识别相关危险因素。
方法
本前瞻性队列研究纳入了在我院被诊断为骨关节炎或类风湿关节炎并接受初次TKA的患者。患者在全身麻醉下接受标准的TKA手术。术后5 - 7天进行胸部CT扫描。采用单因素分析和多因素逻辑回归分析来识别危险因素。
结果
TKA后早期PPCs的总发生率为45.9%。肺炎、胸腔积液和肺不张的发生率分别为14.4%、38.7%和12.6%。较低的体重指数和围手术期输血是PPCs总体的独立危险因素，且与肺不张相关。术后急性低氧血症发作增加了肺炎的风险。单纯输血与胸腔积液有关。
结论
TKA后早期PPCs的发生率较高。对于有相关危险因素的患者，应采取积极措施预防PPCs。
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