80岁以上超高龄患者胸部术后肺部并发症的高危因素分析

摘要

Objective To explore the correlation between the perioperative risk factors and postoperative pulmonary complications in 80 years or older patients undergoing thoracic surgery.Methods Forty-one patients selected from August 2011 to August 2013 with benign lung disease who underwent thoracic surgery were included in this retrospective analysis.Medical records of all patients were reviewed to measure predefined pre-and intraoperative risk factors and postoperative outcomes.Univariate and multivariate analysis was performed to in-vestigate the risk factors of pulmonary complications among the patients by SPSS17.0.Results Postoperative pulmonary complications were seen to occur in 21 of the 41 patients(51.2%),and the most common complication was pneumonia(13 cases),followed by atelectasis(5 ca-ses),hypoxemia(2 cases),pneumothorax(1 cases).Multivariate logistic analysis showed that the BMI≥24,smoking index≥400,FEV1%<65%,MVV<60%,longer duration of surgery and albumin level<30 g/L were the valuable risk factors for prediction of postoperative pul-monary complications.Conclusion Pulmonary complications as a common complication after thoracic surgery is associated with high mortal-ity rates.Our data indicate that BMI,smoking index,FEV1%,MVV,longer duration of surgery and albumin level may be useful to identify high risk patients for pulmonary complications development and adverse outcomes.%目的：分析80岁以上患者行胸部手术后发生肺部并发症的独立危险因素，评估其危险度，以期为其防治提供依据。方法回顾性分析该院2011年8月至2013年8月收治41例80岁以上超高龄患者围术期临床资料。采用 SPSS17．0软件单因素和多因素方法分析患者开胸术后发生肺部并发症的独立危险因素。结果共21例（51．2％）患者发生术后肺部并发症，其中术后肺部感染13例，肺不张5例，低氧血症2例，气胸1例。单因素和多因素分析结果显示，BMI＞24、吸烟指数大于或等于400、第1秒用力呼气容积占用肺活量的百分比（FEV1％）＜65％、最大通气量（MVV）＜60％、手术时间大于或等于4 h和清蛋白水平小于30 g/L是80岁以上超高龄患者胸部手术后发生肺部并发症的独立危险因素。结论 BMI＞24、吸烟指数大于400以及肺功能和营养状况较差的超高龄患者术后发生肺部并发症的风险增加。