肺癌患者开胸行肺叶切除术术后拔管延迟的原因分析

发布时间：2018-04-07 15:04

  本文选题：肺癌　切入点：肺叶切除术　出处：《广西医科大学》2014年硕士论文

【摘要】：目的：通过探讨影响肺癌患者行肺叶切除术后发生拔管延迟的因素。寻找缩短肺癌患者术后机械通气时间的方法,进一步减少术后并发症的发生和住院时间. 方法：采用回顾性调查方法，收集广西肿瘤医院2008年10月～2013年10月间因肺癌在全麻下实施肺叶切除手术患者的临床资料，共收集706例患者资料，，男455例，女251例；年龄22～82岁，平均55岁，其中左肺411例，右肺295例。记录患者一般情况、术前检查、术中和术后管理等相关因素，单因素采用t检验、卡方检验或秩和检验分析数据，多因素采用非条件Logistic回归模型分析方法（LR法）分析与拔管延迟发生率之间的关系。根据是否发生拔管延迟，分为正常拔管组和延迟拔管组。记录两组术后并发症的发生率和住院时间。分析拔管延迟与术后并发症、住院时间的关系。选择2013年11月～2014年3月间24例择期行肺叶切除术的肺癌患者，行双腔支气管插管麻醉，根据术前不同肺功能分为肺功能正常组和肺功能异常组（每组12例），记录两组的术后拔管时间，并发症发生率以及住院时间，分析术前肺功能与术后拔管时机、并发症以及住院时间的关系。 结果：全组术后发生拔管延迟51例，发生率为7.2%。延迟拔管组和正常拔管组术后并发症的发生率分别为35.3%（18/51）和15.6%(102/655)，拔管延迟组的患者术后并发症的发生率明显高于正常拔管组,差异有统计学意义(P＜0.05)。延迟拔管组组和正常拔管组的平均住院时间分别为（17.5±6.2）d和（14.1±7.3）d,延迟拔管组的患者住院时间明显长于正常拔管组，差异有统计学意义(P＜0.05)单因素分析中，有7个因素与开胸行肺叶切除术术后拔管延迟相关（P＜0.05)，分别是年龄，吸烟情况，术前合并症，体重指数，单肺时间，术前白蛋白，术前肺功能。非条件Logistic回归分析提示5个独立危险因素：年龄＞60岁(OR=6.568，P＜0.001)，长时间单肺通气(OR=1.268，P=0.047)，男性(OR=1.511，P=0.046)，尿量＜17ml/h(OR=1.456，P=0.032)，术前肺功能损伤(OR=1.579，P=0.033)。肺功能异常组和肺功能正常组术后拔管时间分别为（190±33）min和(103.9±17) min，肺功能异常组的患者术后带管时间明显久于肺功能正常组,差异有统计学意义(P＜0.05)。肺功能异常组和肺功能正常组术后并发症的发生率分别为66.7%（8/12）和16.7%(2/12)，肺功能异常组的患者术后并发症的发生率明显高于肺功能正常组,差异有统计学意义(P＜0.05)。肺功能异常组和肺功能正常组的平均住院时间分别为（29±5）d和（23±2.3）d,肺功能异常组的患者住院时间明显长于肺功能正常组，差异有统计学意义(P＜0.05) 结论：肺癌患者行肺叶切除术术后拔管延迟会增加术后住院时间和并发症发生；发生术后拔管延迟是多因素协同作用引起的，主要与患者术前较差的肺功能、老年的男性病人、尿量、单肺通气时间长等多种因素相关。术前肺功能异常的患者会显著延长术后的带管时间和住院时间，并具有较高的术后并发症发生率。
[Abstract]:Objective: To investigate the effect of lung cancer patients after lobectomy occurred factors of delayed extubation. Looking for ways to shorten the duration of mechanical ventilation in patients with lung cancer after operation, postoperative complications and hospitalization time was further reduced.
Methods: by retrospective study, from October 2008 to October 2013 in Guangxi cancer hospital for lung cancer under general anesthesia clinical data of lobectomy patients, collected data of 706 patients, 455 were male, 251 were female; the average age is 22~82 years old, 55 years old, including 411 cases of left lung and right lung in 295 cases. Record the general condition of the patient, preoperative examination, intraoperative and postoperative related factors such as management, using the single factor t test, chi square test or rank sum test and data analysis, using multi factor non conditional Logistic regression model analysis method (LR method) analysis and pull the relationship between the incidence of Guan Yanchi. According to the occurrence of delayed extubation, divided into normal extubation group and delayed extubation group. Two groups the incidence of postoperative complications and hospitalization time. Analysis of delayed extubation and postoperative complications, hospitalization time. Relationship between November 2013 and March 2014 24 cases of elective Lobectomy of lung cancer patients underwent double lumen endobronchial intubation, according to preoperative pulmonary function was divided into normal lung function group and abnormal pulmonary function group (12 cases each), two groups of postoperative extubation time, complication rate and hospitalization time of preoperative pulmonary function and timing of extubation after the relationship between complications and hospitalization time.
缁撴灉锛氬叏缁勬湳鍚庡彂鐢熸嫈绠″欢杩

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