Division of Respiratory Diseases, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, Japan.
BMC Pulm Med. 2018 Jan 9;18(1):4. doi: 10.1186/s12890-017-0570-8.
Postoperative pulmonary complications (PPC) in patients with pulmonary diseases remain to be resolved clinical issue. However, most evidence regarding PPC has been established more than 10 years ago. Therefore, it is necessary to evaluate perioperative management using new inhalant drugs in patients with obstructive pulmonary diseases.
April 2014 through March 2015, 346 adult patients with pulmonary diseases (257 asthma, 89 chronic obstructive pulmonary disease (COPD)) underwent non-pulmonary surgery except cataract surgery in our university hospital. To analyze the risk factors for PPC, we retrospectively evaluated physiological backgrounds, surgical factors and perioperative specific treatment for asthma and COPD.
Finally, 29 patients with pulmonary diseases (22 asthma, 7 COPD) had PPC. In patients with asthma, smoking index (≥ 20 pack-years), peripheral blood eosinophil count (≥ 200/mm) and severity (Global INitiative for Asthma(GINA) STEP ≥ 3) were significantly associated with PPC in the multivariate logistic regression analysis [odds ratio (95% confidence interval) = 5.4(1.4-20.8), 0.31 (0.11-0.84) and 3.2 (1.04-9.9), respectively]. In patients with COPD, age, introducing treatment for COPD, upper abdominal surgery and operation time (≥ 5 h) were significantly associated with PPC [1.18 (1.00-1.40), 0.09 (0.01-0.81), 21.2 (1.3-349) and 9.5 (1.2-77.4), respectively].
History of smoking or severe asthma is a risk factor of PPC in patients with asthma, and age, upper abdominal surgery, or long operation time is a risk factor of PPC in patients with COPD. Adequate inhaled corticosteroids treatment in patients with eosinophilic asthma and introducing treatment for COPD in patients with COPD could reduce PPCs.
肺部疾病患者的术后肺部并发症（PPC）仍然是一个待解决的临床问题。然而，大多数关于 PPC 的证据都是 10 多年前建立的。因此，有必要评估使用新的吸入性药物治疗阻塞性肺疾病患者的围手术期管理。
2014 年 4 月至 2015 年 3 月，我院对 346 例非白内障肺部疾病（257 例哮喘，89 例慢性阻塞性肺疾病（COPD））成年患者进行了非肺部手术。为分析 PPC 的危险因素，我们回顾性评估了哮喘和 COPD 的生理背景、手术因素和围手术期特殊治疗。
最终，29 例肺部疾病患者（22 例哮喘，7 例 COPD）发生 PPC。在哮喘患者中，吸烟指数（≥20 包年）、外周血嗜酸性粒细胞计数（≥200/mm）和严重程度（全球哮喘倡议（GINA） STEP≥3）在多变量逻辑回归分析中与 PPC 显著相关[比值比（95%置信区间）=5.4（1.4-20.8）、0.31（0.11-0.84）和 3.2（1.04-9.9）]。在 COPD 患者中，年龄、COPD 治疗的引入、上腹部手术和手术时间（≥5 小时）与 PPC 显著相关[1.18（1.00-1.40）、0.09（0.01-0.81）、21.2（1.3-349）和 9.5（1.2-77.4）]。
吸烟史或严重哮喘是哮喘患者 PPC 的危险因素，年龄、上腹部手术或手术时间长是 COPD 患者 PPC 的危险因素。在嗜酸性粒细胞性哮喘患者中给予足够的吸入性皮质类固醇治疗和在 COPD 患者中引入治疗可减少 PPC。
