Pasin Laura, Nardelli Pasquale, Belletti Alessandro, Greco Massimiliano, Landoni Giovanni, Cabrini Luca, Chiesa Roberto, Zangrillo Alberto
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina, Milan, Italy.
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina, Milan, Italy.
J Cardiothorac Vasc Anesth. 2017 Apr;31(2):562-568. doi: 10.1053/j.jvca.2016.09.034. Epub 2016 Oct 1.
Postoperative pulmonary complications (PPC) are among the most common complications after noncardiac surgery. Men, smokers, and elderly patients with chronic obstructive pulmonary disease or heart failure are more likely to experience PPC. The majority of patients undergoing vascular surgery belong in these categories and are at higher risk of developing PPC. Moreover, the surgical site is one of the most important risk factors associated with PPC, and aortic surgery carries the highest risk. The aim of this systematic review was to obtain an additional understanding of the real incidence of PPC after open abdominal aortic surgery and the impact of PPC on survival.
Systematic review and meta-analysis.
Hospitals PARTICIPANTS: Patients who underwent open abdominal aortic surgery.
None.
A literature search was performed on BioMedCentral, PubMed, Embase, and the Cochrane Register of clinical trials. All prospective or retrospective studies reporting data on PPC after open abdominal aortic surgery were included. Co-primary endpoints were the PPC rate and the correlation between PPC and perioperative mortality. The secondary endpoint was the difference in the PPC rate and mortality between elective and urgent surgery. Data on 269,637 patients from 213 studies were analyzed. The overall median incidence of PPC was 10.3% (interquartile range 5.55%-19.1%). Pneumonia, respiratory insufficiency, prolonged mechanical ventilation, need for unplanned mechanical ventilation, atelectasis, acute respiratory distress syndrome, pulmonary edema, and pleural effusions were the most common PPC reported in the literature. Occurrence of PPC was associated with postoperative mortality (r = 0.65, p<0.01) and was significantly higher in urgent procedures (p<0.001).
Incidence of PPC after open abdominal aortic surgery is high and is associated with increased postoperative morbidity and mortality.
术后肺部并发症（PPC）是心脏非手术术后最常见的并发症之一。男性、吸烟者以及患有慢性阻塞性肺疾病或心力衰竭的老年患者更易发生PPC。大多数接受血管手术的患者属于此类，发生PPC的风险更高。此外，手术部位是与PPC相关的最重要风险因素之一，主动脉手术的风险最高。本系统评价的目的是进一步了解开放性腹主动脉手术后PPC的实际发生率以及PPC对生存率的影响。
系统评价和荟萃分析。
医院
接受开放性腹主动脉手术的患者。
无。
在生物医学中心、PubMed、Embase和Cochrane临床试验注册库进行文献检索。纳入所有报告开放性腹主动脉手术后PPC数据的前瞻性或回顾性研究。共同主要终点为PPC发生率以及PPC与围手术期死亡率之间的相关性。次要终点为择期手术与急诊手术之间PPC发生率和死亡率的差异。分析了来自213项研究的269,637例患者的数据。PPC的总体中位发生率为10.3%（四分位间距5.55%-19.1%）。肺炎、呼吸功能不全、机械通气时间延长、需要非计划机械通气、肺不张、急性呼吸窘迫综合征、肺水肿和胸腔积液是文献中报告的最常见的PPC。PPC的发生与术后死亡率相关（r = 0.65，p<0.01），在急诊手术中显著更高（p<0.001）。
开放性腹主动脉手术后PPC的发生率很高，且与术后发病率和死亡率增加相关。
