Miyahara Shunsuke, Miyata Hiroaki, Motomura Noboru, Takamoto Shinichi, Okita Yutaka
Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Health Care Quality Assessment, University of Tokyo, Tokyo, Japan.
Eur J Cardiothorac Surg. 2017 Apr 1;51(4):761-766. doi: 10.1093/ejcts/ezw417.
We investigated the impact of chronic obstructive pulmonary disease (COPD) on in-hospital outcomes of patients undergoing conventional total aortic arch replacement (TAR), based on the Japan Adult Cardiovascular Surgery Database.
A total of 12 590 patients who underwent elective TAR between 2008 and 2013 were retrospectively reviewed. Patients were divided into 4 categories: normal respiratory function (control), with ratio of forced expiratory volume of air in 1 s (FEV 1 ) to forced vital capacity (FVC) of 76% or greater (TAR, n = 10 040); mild COPD, with FEV 1 /FVC ratio 60-75% and/or use of bronchodilator (TAR, n = 1890); moderate COPD, FEV 1 /FVC ratio 50 to 59% and/or use of steroids (TAR, n = 504); and severe COPD, FEV 1 /FVC ratio less than 50% and/or presence of respiratory failure (TAR, n = 156).
In-hospital mortality was 5.7% (5.2% in controls, 7.0% in mild COPD, 9.3% in moderate COPD and 9.0% in severe COPD). A significant trend towards the severity of COPD was noted ( P < 0.0001). A higher incidence of postoperative pneumonia (6.0% in control, 11.0% in mild COPD, 12.3% in moderate COPD and 15.4% in severe COPD; P < 0.0001) and a greater need for prolonged ventilation (17.5% in control, 22.0% in mild COPD, 26.6% in moderate COPD and 29.5% in severe COPD; P < 0.0001) were observed in cases of more severe COPD. The odds ratio of moderate/severe COPD for in-hospital mortality was 1.44 with confidence interval of 1.08-1.91 ( P = 0.012).
There was a significant increase in in-hospital mortality and morbidity with increasing severity of COPD in patients who underwent TAR.
基于日本成人心血管外科数据库，我们调查了慢性阻塞性肺疾病（COPD）对接受传统全主动脉弓置换术（TAR）患者院内结局的影响。
回顾性分析了2008年至2013年间共12590例行择期TAR的患者。患者分为4类：呼吸功能正常（对照组），1秒用力呼气容积（FEV1）与用力肺活量（FVC）之比为76%或更高（TAR组，n = 10040）；轻度COPD，FEV1/FVC比值为60 - 75%和/或使用支气管扩张剂（TAR组，n = 1890）；中度COPD，FEV1/FVC比值为50 - 59%和/或使用类固醇（TAR组，n = 504）；重度COPD，FEV1/FVC比值小于50%和/或存在呼吸衰竭（TAR组，n = 156）。
院内死亡率为5.7%（对照组为5.2%，轻度COPD为7.0%，中度COPD为9.3%，重度COPD为9.0%）。观察到COPD严重程度存在显著趋势（P < 0.0001）。在COPD更严重的病例中，术后肺炎的发生率更高（对照组为6.0%，轻度COPD为11.0%，中度COPD为12.3%，重度COPD为15.4%；P < 0.0001），且需要更长时间通气的需求更大（对照组为17.5%，轻度COPD为22.0%，中度COPD为26.6%，重度COPD为29.5%；P < 0.0001）。中度/重度COPD院内死亡的比值比为1.44，置信区间为1.08 - 1.91（P = 0.012）。
接受TAR的患者中，随着COPD严重程度增加，院内死亡率和发病率显著升高。
