腹腔镜胰十二指肠切除术患者术后肺部并发症影响因素探讨

发布时间：2018-06-29 11:07

本文选题：腹腔镜胰十二指肠切除术 + 肺部并发症　；参考：《河北医科大学》2017年硕士论文

【摘要】：腹腔镜胰十二指肠切除术(Laparoscopic Pancreaticoduodenectomy,LPD)是腹部外科最大的手术,术后并发症发生率高,病死率高。自1992年国外实施第一例LPD后,经过20多年的发展,其安全性和实用性已得到证实。我院肝胆外科腹腔镜技术日趋成熟,2014年积极开展LPD,至今已实施全腔镜下LPD逾200例,其技术水平位居国内领先。腹腔镜CO_2气腹对呼吸系统影响大,LPD长时间腹腔镜手术操作极易出现肺部感染、肺不张等术后肺部相关并发症;拟行此术式的患者多为老年人,呼吸系统生理功能改变明显,通气储备下降,使得LPD患者术后肺部并发症(Postoperative Pulmonary Complications,PPCs)发生风险增高。通过查阅文献,针对该术式患者PPCs的研究少有报道。本研究主要通过对接受LPD患者的临床资料进行回顾性分析,对其术前、术中及术后临床资料相关数据进行统计处理,得到结果并加以分析,最终总结LPD患者PPCs的高危因素,为临床长时间腹腔镜手术的麻醉管理提供参考。目的:回顾性分析LPD患者围术期相关资料,探讨LPD患者PPCs高危因素,以期进一步优化LPD围术期麻醉管理,降低PPCs发生率。方法:对2015年10月-2017年1月在河北医科大学第二医院肝胆外科行择期LPD的100例患者的临床资料进行回顾性分析,按术后是否发生肺部并发症分为肺部并发症组和非肺部并发症组,记录并比较两组患者围术期相关资料:性别、年龄、BMI值、ASA分级、吸烟史、慢性阻塞性肺疾患(COPD)、高血压、糖尿病、冠心病、肝功能分级、吸入氧浓度(FiO_2)、术中输血、术中输液量、术中保温、术中应用乌司他丁、术后镇痛、ICU留观、手术时长、术后住院时长共19个变量信息,其中对单因素分析结果中有方差差异的变量行Logistic回归多因素分析。结果:1分析100例LPD患者临床资料,确诊发生PPCs者33例,其发生率为33%。2单因素分析结果显示:肺部并发症组吸烟史、COPD、100%FiO_2、术中应用乌司他丁、留观ICU发生率分别为:30.3%、33.3%、84.8%、9.1%、66.7%,非肺部并发症组分别为:19.4%、14.9%、50.7%、29.9%、17.9%,以上五项变量两组比较差异有统计学意义(P0.05)。3 t检验结果:肺部并发症组年龄(63.30±8.33)岁,术后住院时长(29.91±20.89)天,非肺部并发症组年龄(58.16±9.52)岁,术后住院时长(19.30±8.18)天,以上两项变量两组比较差异有统计学意义(P0.05)。4将以上差异有统计学意义的7个变量进行Logistic多因素回归分析,结果3个变量进入最终回归方程:吸烟史(OR=0.218;95%CI:0.068-0.694;P=0.010)、COPD(OR=0.043;95%CI:0.008-0.223;P=0.000)、FiO_2(OR=0.167;95%CI:0.038-0.740;P=0.018)为LPD患者术后发生肺部并发症的高危因素。结论:术前有吸烟史、合并COPD病史、术中麻醉期间100%FiO_2为LPD患者PPCs发生的高危因素,针对这些因素进行干预或许能降低LPD患者PPCs的发生可能;术前无吸烟史、不合并COPD病史、合适的Fi O_2显著缩短LPD患者术后住院时长,利于患者术后康复。
[Abstract]:Laparoscopic pancreaticoduodenectomy (LPD) is the largest operation in abdominal surgery. Since the first case of LPD was implemented abroad in 1992, its safety and practicability have been proved after more than 20 years of development. The laparoscopic technique of hepatobiliary surgery in our hospital is maturing day by day. LPDs were carried out actively in 2014. Up to now, more than 200 cases of LPD have been implemented under full laparoscopy, and the technical level of LPD is the leading in China. Effect of LPD LPD on respiratory system: lung infection and atelectasis are easy to occur after LPD operation, and the patients who plan to perform this operation are mostly elderly, and the physiological function of respiratory system is obviously changed. The decrease of ventilation reserve increases the risk of Postoperative pulmonary complements PPCs in patients with LPD. By consulting the literature, there are few reports on PPCs in patients undergoing this procedure. In this study, the clinical data of patients with LPD were analyzed retrospectively, and the clinical data before, during and after LPD were statistically analyzed, the results were obtained and analyzed, and the high risk factors of PPCs in patients with LPD were summarized. To provide a reference for clinical long-term laparoscopic surgery anesthetic management. Objective: to study the risk factors of PPCs in patients with LPD and to optimize anesthesia management and reduce the incidence of PPCs in LPD patients. Methods: the clinical data of 100 patients undergoing elective LPD from October 2015 to January 2017 in the second Hospital of Hebei Medical University were retrospectively analyzed. Pulmonary complications were divided into pulmonary complications group and non-pulmonary complication group according to postoperative complications. The data of perioperative period were recorded and compared between the two groups: sex, age and BMI, smoking history, chronic obstructive pulmonary disease (COPD), hypertension. Diabetes mellitus, coronary heart disease, liver function grading, FiOs2, intraoperative transfusion, intraoperative infusion, intraoperative heat preservation, intraoperative application of ulinastatin, postoperative analgesia and ICU stay, length of operation, and postoperative hospitalization were 19 variables. Among them, multivariate logistic regression analysis was carried out for the variables with variance differences in the results of univariate analysis. Results the clinical data of 100 patients with LPD were analyzed by 1: 1. 33 cases of PPCs were diagnosed. The incidence rate of PPCs was 33.2 the results of univariate analysis showed that the smoking history of pulmonary complication group was 100 FiOStat 2, and ulinastatin was used during operation. The incidences of ICU in ICU were respectively: 84.83.33. 84.8and 9.1and 66.7, respectively. In the group of non-pulmonary complications, they were: 19.4and 14.90.75. The difference between the above five variables was statistically significant (P0.05) t test: the age of pulmonary complication group was (63.30 卤8.33) years, and the length of hospital stay was (29.91 卤20.89) days after operation, the difference was statistically significant (P0.05) t test results showed that the age of pulmonary complication group was (63.30 卤8.33) years old, and the length of hospital stay was (29.91 卤20.89) days after operation. The age of non-pulmonary complication group was (58.16 卤9.52) years old, and the length of hospitalization was (19.30 卤8.18) days after operation. There was significant difference between the two groups (P0.05). Results three variables entered the final regression equation: the history of smoking (OR 0.218995 CI: 0.068-0.694P0.010) and COPD (OR0.0439.95 CI: 0.008-0.223P0.000) FiOster2 (OR0.167C95: CI0.038-0.740P0.018) were the risk factors for postoperative pulmonary complications in patients with LPD. Conclusion: there is a history of smoking before operation, a history of COPD, and 100 FiO-2 during anaesthesia during operation are the high risk factors of PPCs in patients with LPD. Intervention against these factors may reduce the possibility of PPCs in patients with LPD, no smoking history before operation, no history of COPD, no history of smoking before operation, no history of COPD, no history of smoking before operation, and no history of COPD. Appropriate FiO 2 significantly shortened the length of stay in patients with LPD and was beneficial to postoperative recovery.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

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