术前干预对腹部外科COPD病人肺部并发症的影响

发布时间：2018-09-11 18:53

【摘要】：研究背景：随着社会老龄化不断加剧,外科病人中COPD (Chronic Obstructive Pulmonary Disease,慢性阻塞性肺疾病)患者日趋增多。COPD患者免疫及应激能力低下,手术风险大,术后PPC (Postoperative Pulmonary Complications,术后肺部并发症)等并发症多,约占整个术后并发症的40%。PPC的发生受诸多因素影响如年龄、手术部位、麻醉方式、手术时间及COPD严重程度等,术前合并COPD病人PPC发生率是正常人的20倍,常造成患者术后呼吸衰竭、切口裂开的并发症,严重者死亡率明显增加。目前对于围手术期的COPD病人如何进行PPC预防尚无明确的标准,外科医生对PPC的认知不足,术后PPC发生率仍高达30%。如何正确的预防PPC的发生引起我们的高度重视。目的：探讨通过对围手术期呼吸系统的管理,减少COPD病人PPC发生率。方法：本文对2007年1月～2013年2月大连医科大学附属第二医院普外科收治的围手术期COPD患者病例进行回顾性分析,对治疗组和对照组PPC的发生率进行比较分析。采用SPSS13.0软件进行数据处理,治疗前后数据比较用配对t检验；组间计数资料的比较用χ2检验,选择检验水平a=0.05,P0.05认为有统计学差异明显。结果：治疗组发生肺炎2例,发生率为7.6%(无呼吸衰竭),呼吸衰竭3例,发生率11.5%为(均无肺不张及肺炎)(表2)。对照组发生肺不张2例(发生率6.6%),发生肺炎6例(20%),呼吸衰竭5例(16.6%)。对照组发生切口裂开1例,经换药对症治疗后愈合。对照组其中1人术后因肺不张、肺炎、呼吸衰竭入ICU行呼吸机治疗,两组患者经治疗后均治愈出院,无死亡。治疗组和对照组有显著差异(P0.05)。COPD病人术前采取干预对于减少PPC发生非常重要。结论：对COPD病人术前采取积极有效的综合干预治疗,能降低并发症的发生,减少住院天数,降低手术风险。
[Abstract]:BACKGROUND: With the aging of society, COPD (Chronic Obstructive Pulmonary Disease) is becoming more and more common in surgical patients. The immune and stress abilities of COPD patients are low, the risk of operation is high, and there are many postoperative complications such as PPC (Postoperative Pulmonary Complications), which account for about 10%. The occurrence of PPC is affected by many factors such as age, operation site, anesthesia method, operation time and severity of COPD. The incidence of PPC in patients with COPD before operation is 20 times higher than that in normal people. It often causes postoperative respiratory failure and complications of incision dehiscence. The mortality rate of severe cases increases significantly. There is no definite standard for prophylaxis of PPC in patients with COPD of stage I. Surgeons have not enough knowledge of PPC and the incidence of PPC is still as high as 30%. How to prevent PPC correctly has aroused our great attention.
Objective: to reduce the incidence of PPC in COPD patients through perioperative management of respiratory system.
Methods: Retrospective analysis was made on the perioperative COPD patients admitted to the General Surgery Department of the Second Affiliated Hospital of Dalian Medical University from January 2007 to February 2013. The incidence of PPC in the treatment group and the control group was compared and analyzed. The data were compared with chi square test, and the test level was a=0.05. P0.05 thought there was significant difference between the 2.
Results: The incidence of pneumonia in the treatment group was 7.6% (no respiratory failure), and respiratory failure in 3 cases (no atelectasis and pneumonia) (Table 2). In the control group, atelectasis occurred in 2 cases (incidence 6.6%), pneumonia in 6 cases (20%) and respiratory failure in 5 cases (16.6%). One patient was admitted to ICU for ventilator treatment because of atelectasis, pneumonia and respiratory failure after operation. Both groups were cured and discharged without death. There was significant difference between the treatment group and the control group (P 0.05). Preoperative intervention of COPD patients was very important to reduce the incidence of PPC.
Conclusion: Preoperative comprehensive intervention for COPD patients can reduce complications, hospitalization days and operation risk.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R656;R563.9

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