Furuya Kenta, Sakamoto Susumu, Takai Yujiro, Sato Nobukazu, Matsumoto Keiko, Homma Sakae
Division of Respiratory Medicine, Toho University Omori Medical Center.
Division of Anesthesiology, Toho University Omori Medical Center.
Sarcoidosis Vasc Diffuse Lung Dis. 2017;34(2):156-164. doi: 10.36141/svdld.v34i2.5366. Epub 2017 Apr 28.
Idiopathic interstitial pneumonia (IIP) is associated with increased risk of acute exacerbation after lung surgery, which has a poor prognosis and can be fatal. Although some studies have investigated acute exacerbation of IIP after lung surgery, the incidence and risks of acute exacerbation of IIP after nonpulmonary surgery have not been reported. The aim of present study to evaluate the characteristics and risk factors for acute exacerbation of IIP after nonpulmonary surgery. We retrospectively reviewed the clinical characteristics of 2908 consecutive patients (1620 men, 1288 women; mean age, 61.7) who underwent nonpulmonary surgery under general anesthesia between April 2008 to April 2013. Using preoperative chest computed tomography images, we identified IIP cases and compared preoperative characteristics, laboratory findings, and anesthesia conditions among patients who did and did not develop AE. We extracted 103 IIP patients who underwent nonpulmonary surgery; postoperative acute exacerbation of IIP developed in 8 (7.8%). Univariate analysis identified several risk factors, namely, emergency surgery, preoperative prednisolone use, high serum C-reactive protein, lactate dehydrogenase, white blood cell count, low serum albumin and propofol use during anesthesia. The results suggest that the incidences of postoperative acute exacerbation of IIP are similar after nonpulmonary and pulmonary surgery. In addition, propofol use during anesthesia is a possible risk factor for acute exacerbation of IIP after nonpulmonary surgery. .
特发性间质性肺炎（IIP）与肺手术后急性加重风险增加相关，其预后较差且可能致命。尽管一些研究调查了肺手术后IIP的急性加重情况，但非肺手术后IIP急性加重的发生率和风险尚未见报道。本研究旨在评估非肺手术后IIP急性加重的特征和危险因素。我们回顾性分析了2008年4月至2013年4月期间连续2908例接受全身麻醉下非肺手术患者（1620例男性，1288例女性；平均年龄61.7岁）的临床特征。利用术前胸部计算机断层扫描图像，我们确定了IIP病例，并比较了发生和未发生急性加重（AE）患者的术前特征、实验室检查结果及麻醉情况。我们提取了103例接受非肺手术的IIP患者；其中8例（7.8%）术后发生了IIP急性加重。单因素分析确定了几个危险因素，即急诊手术、术前使用泼尼松龙、血清高C反应蛋白、乳酸脱氢酶、白细胞计数、血清低白蛋白以及麻醉期间使用丙泊酚。结果表明，非肺手术和肺手术后IIP术后急性加重的发生率相似。此外，麻醉期间使用丙泊酚可能是非肺手术后IIP急性加重的一个危险因素。
