食管癌切除术后的急性呼吸窘迫综合征：两项试验的比较

ARDS following oesophagectomy: a comparison of two trials.

作者信息

Howells Phillip A, Aldridge Kerrie A, Parekh Dhruv, Park Daniel, Tucker Olga, Dancer Rachel C A, Gao Fang, Perkins Gavin D, Thickett David R

机构信息

Peri-operative and critical care trials group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.

Department of Respiratory Medicine, University Hospitals Birmingham NHS Trust, Birmingham, UK.

出版信息

BMJ Open Respir Res. 2017 Nov 2;4(1):e000207. doi: 10.1136/bmjresp-2017-000207. eCollection 2017.

DOI:10.1136/bmjresp-2017-000207

PMID:29435341

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5687524/

Abstract

INTRODUCTION

The Beta Agonist Lung Injury Trial-Prevention (BALTI-P) translational substudy and Vitamin D to Prevent Acute Lung Injury Following Oesophagectomy (VINDALOO) trials recruited patients undergoing oesophagectomy, 4 years apart. The acute respiratory distress syndrome (ARDS) rates were lower in the VINDALOO trial. We sought to identify changes between these two trials and identify risk factors for ARDS in oesophagectomy.

METHODS

There were data available from 61 patients in the BALTI-P substudy and 68 from VINDALOO. Databases were available for both trials; additional data were collected. Multivariate logistic regression was used to analyse risk factors for ARDS and postoperative complications in the cohorts combined.

RESULTS

Logistic regression analysis showed active smoking was associated with an increase in ARDS (OR 3.91; 95% CI 1.33 to 11.5) and dihydropyridine use (OR 5.34;95% CI 1.56 to 18.3). Hospital length of stay was longer for those who took dihydropyridines (median 29 days (IQR 17-42) vs 13 days (IQR 10-18), P=0.0007) or were diabetic (median 25 days (IQR 14-39) vs 13 (IQR 10-19), P=0.023) but not for current smokers (median in never/ex-smokers 13 (IQR 10-23) vs current smokers 15 (IQR 11-20), P=0.73).

CONCLUSIONS

Smoking cessation trials should be promoted. Dihydropyridine effects perioperatively require further clinical and mechanistic evaluation. Patients undergoing oesophagectomy are a useful model for studying perioperative ARDS.

摘要

引言

β受体激动剂肺损伤预防试验（BALTI-P）转化亚研究和维生素D预防食管癌切除术后急性肺损伤试验（VINDALOO）相隔4年招募了接受食管癌切除术的患者。VINDALOO试验中的急性呼吸窘迫综合征（ARDS）发生率较低。我们试图确定这两项试验之间的变化，并确定食管癌切除术中ARDS的危险因素。

方法

BALTI-P亚研究中有61例患者的数据，VINDALOO中有68例患者的数据。两项试验都有数据库；还收集了额外的数据。使用多因素逻辑回归分析联合队列中ARDS和术后并发症的危险因素。

结果

逻辑回归分析显示，主动吸烟与ARDS增加相关（比值比3.91；95%置信区间1.33至11.5）以及使用二氢吡啶相关（比值比5.34；95%置信区间1.56至18.3）。服用二氢吡啶的患者住院时间更长（中位数29天（四分位间距为17 - 42）对13天（四分位间距为10 - 18），P = 0.0007）或糖尿病患者住院时间更长（中位数25天（四分位间距为14 - 39）对13天（四分位间距为10 - 19），P = 0.023），但当前吸烟者住院时间无差异（从不吸烟者/既往吸烟者中位数13天（四分位间距为10 - 23）对当前吸烟者15天（四分位间距为11 - 日），P = 0.73）。