Windsor J A, Hill G L
Department of Surgery, University of Auckland School of Medicine, New Zealand.
Ann Surg. 1988 Aug;208(2):209-14. doi: 10.1097/00000658-198808000-00013.
Pulmonary complications remain the most important cause of postoperative morbidity and mortality. The many advances of modern surgical care over the last 30 years have not appreciably altered the incidence of these complications. Many risk factors have been shown to contribute to this problem, but no studies have examined the impact of preoperative protein depletion on respiratory function and related this to the development of postoperative pulmonary complications. 80 patients (42 men, 38 women, median age of 64 years, with a range of 15-91 years) awaiting major elective gastrointestinal (G.I.) surgery were divided into two categories on the basis of a direct measurement of protein depletion: nonprotein-depleted patients (n = 41, mean protein loss, 2% +/- 1.7 SEM) and protein-depleted patients (n = 39, mean protein loss, 36% +/- 3.5 SEM). There was no significant difference between these two categories in regard to age, height, sex, surgical diagnosis, the presence of chronic lung disease, smoking, proportion of upper abdominal incisions, degree of obesity, the duration of anesthesia, and the use of prophylactic antibiotics and physiotherapy. There was a significant difference between these two categories of patients in regard to respiratory muscle strength (p less than .025), vital capacity (p less than .05), and peak expiratory flow rate (p less than .005). Pneumonia developed in a significantly higher proportion of protein-depleted patients with atelectasis (p less than .05), and their stay in the hospital after surgery was longer (p less than .05). These data show that protein depletion is associated with an impairment of respiratory function, and is in itself a significant risk factor in the development of postoperative pneumonia.
肺部并发症仍然是术后发病和死亡的最重要原因。在过去30年里，现代外科护理取得了许多进展，但这些并发症的发生率并未明显改变。许多风险因素已被证明与这一问题有关，但尚无研究探讨术前蛋白质消耗对呼吸功能的影响，并将其与术后肺部并发症的发生联系起来。80例等待择期胃肠道大手术的患者（42例男性，38例女性，中位年龄64岁，年龄范围15 - 91岁），根据蛋白质消耗的直接测量结果分为两类：非蛋白质消耗患者（n = 41，平均蛋白质丢失2% ± 1.7 SEM）和蛋白质消耗患者（n = 39，平均蛋白质丢失36% ± 3.5 SEM）。这两类患者在年龄、身高、性别、手术诊断、慢性肺病的存在、吸烟、上腹部切口比例、肥胖程度、麻醉持续时间以及预防性抗生素和物理治疗的使用方面没有显著差异。这两类患者在呼吸肌力量（p <.025）、肺活量（p <.05）和呼气峰值流速（p <.005）方面存在显著差异。蛋白质消耗且有肺不张的患者发生肺炎的比例显著更高（p <.05），并且他们术后住院时间更长（p <.05）。这些数据表明，蛋白质消耗与呼吸功能受损有关，其本身就是术后肺炎发生的一个重要风险因素。
