Lee Hyo Jin, Lee Hyun Woo
Division of Respiratory and Critical Care, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea.
Tuberc Respir Dis (Seoul). 2025 Jan;88(1):90-108. doi: 10.4046/trd.2024.0118. Epub 2024 Oct 30.
Postoperative pulmonary complications (PPCs) significantly increase morbidity and mortality in surgical patients, particularly those with pulmonary conditions. PPC incidence varies widely, influenced by factors such as surgery type, patient age, smoking status, and comorbid conditions, including chronic obstructive pulmonary disease (COPD) and congestive heart failure. While preoperative pulmonary function tests and chest radiographs are crucial for lung resection surgery, their use should be judiciously tailored to individual risk profiles. Effective risk stratification models, such as the American Society of Anesthesiologists classification, Arozullah respiratory failure index, Gupta Calculators, and Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) model, play a key role in predicting PPCs. Key strategies to diminish PPCs include preoperative optimization of respiratory conditions, smoking cessation, and respiratory rehabilitation. In patients with COPD and asthma, it is crucial to maintain optimal disease control through inhaled therapies, systemic corticosteroids, and tailored preoperative respiratory exercises. Anemia and hypoalbuminemia are significant predictors of PPCs and require meticulous management. The choice and duration of anesthesia also notably influence PPC risk, with regional anesthesia being preferable to general anesthesia when possible. Comprehensive preoperative evaluations and tailored interventions are essential for enhancing surgical outcomes and reducing PPC incidence. Additional studies involving domestic patients are necessary to refine national guidelines for managing those at risk of PPCs.
术后肺部并发症（PPCs）显著增加手术患者的发病率和死亡率，尤其是患有肺部疾病的患者。PPC的发生率差异很大，受手术类型、患者年龄、吸烟状况以及合并症（包括慢性阻塞性肺疾病（COPD）和充血性心力衰竭）等因素影响。虽然术前肺功能测试和胸部X光片对肺切除手术至关重要，但应根据个体风险状况谨慎使用。有效的风险分层模型，如美国麻醉医师协会分类、阿罗祖拉呼吸衰竭指数、古普塔计算器以及加泰罗尼亚外科患者呼吸风险评估（ARISCAT）模型，在预测PPCs方面发挥着关键作用。减少PPCs的关键策略包括术前优化呼吸状况、戒烟和呼吸康复。对于患有COPD和哮喘的患者，通过吸入疗法、全身用皮质类固醇以及量身定制的术前呼吸锻炼来维持最佳疾病控制至关重要。贫血和低白蛋白血症是PPCs的重要预测因素，需要精心管理。麻醉的选择和持续时间也显著影响PPC风险，尽可能选择区域麻醉而非全身麻醉。全面的术前评估和量身定制的干预措施对于提高手术效果和降低PPC发生率至关重要。有必要开展更多涉及国内患者的研究，以完善针对有PPC风险患者的国家管理指南。
