Mitchell C K, Smoger S H, Pfeifer M P, Vogel R L, Pandit M K, Donnelly P J, Garrison R N, Rothschild M A
Department of Medicine, University of Louisville, Ky 40292, USA.
Arch Surg. 1998 Feb;133(2):194-8. doi: 10.1001/archsurg.133.2.194.
To develop a predictive model identifying perioperative conditions associated with postoperative pulmonary complications (PPCs).
A prospective survey of patients whose preoperative history and physical examination, spirometric, PaO2 and PaCO2 analysis, and operative results were recorded. These patients underwent postoperative cardiopulmonary examinations until they were discharged from the hospital; their medical records were also reviewed until they were discharged from the hospital.
The Louisville Veterans Administration Medical Center, Louisville, Ky.
A randomly chosen sample of patients aged 40 years or older who required elective, nonthoracic surgery under general or spinal anesthesia and who were hospitalized at least 24 hours postoperatively.
An analysis of risk factors associated with the development of 1 or more of the following conditions: acute bronchitis, bronchospasm, atelectasis, pneumonia, adult respiratory distress syndrome, pleural effusion, pneumothorax, prolonged mechanical ventilation, or death secondary to acute respiratory failure.
Postoperative pulmonary complications developed in 16 (11%) of 148 patients. The risk factors found to be higher among those with PPCs compared with those without PPCs were postoperative nasogastric intubation (81% vs 16%, P<.001), preoperative sputum production (56% vs 21%, P=.005), and longer anesthesia duration (480 vs 309 minutes, P<.001). Upper abdominal surgery was performed in 11 (69%) of the 16 patients with PPCs and in 20 (15%) of the 132 patients without PPCs (P<.001); this difference lost significance in multivariate analysis. The final linear logistic model included postoperative nasogastric intubation (odds ratio [OR], 21.8), preoperative sputum production (OR, 4.6), and longer anesthesia duration (OR exp[0.01x] for an increase in x minutes) (1 minute of additional anesthesia time increases the OR to 1.01), resulting in 92% accuracy in predicting PPCs.
We identified 3 potentially modifiable risk factors for PPCs. If validated, our results may lead to modifications of perioperative care that will further reduce PPCs.
建立一个预测模型，以识别与术后肺部并发症（PPCs）相关的围手术期情况。
对术前病史、体格检查、肺功能、动脉血氧分压和二氧化碳分压分析以及手术结果进行记录的患者进行前瞻性调查。这些患者术后接受心肺检查直至出院；其病历在出院前也会被审查。
肯塔基州路易斯维尔市的路易斯维尔退伍军人管理局医疗中心。
随机选取的40岁及以上患者样本，这些患者需要在全身麻醉或脊髓麻醉下进行择期非胸科手术，且术后住院至少24小时。
分析与以下一种或多种情况发生相关的危险因素：急性支气管炎、支气管痉挛、肺不张、肺炎、成人呼吸窘迫综合征、胸腔积液、气胸、机械通气时间延长或急性呼吸衰竭继发死亡。
148例患者中有16例（11%）发生术后肺部并发症。与未发生PPCs的患者相比，发生PPCs的患者中术后鼻胃管插管（81%对16%，P<0.001）、术前咳痰（56%对21%，P=0.005）以及麻醉持续时间更长（480对309分钟，P<0.001）等危险因素更为常见。16例发生PPCs的患者中有11例（69%）接受了上腹部手术，132例未发生PPCs的患者中有20例（15%）接受了上腹部手术（P<0.001）；在多变量分析中这种差异失去了显著性。最终的线性逻辑模型包括术后鼻胃管插管（比值比[OR]，21.8）、术前咳痰（OR，4.6）以及麻醉持续时间更长（每增加x分钟，OR为exp[0.01x]）（额外1分钟麻醉时间使OR增加到1.01），预测PPCs的准确率为92%。
我们确定了3个PPCs的潜在可改变危险因素。如果得到验证，我们的结果可能会导致围手术期护理的改进，从而进一步降低PPCs的发生率。
