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目的分析围手术期合并慢性阻塞性肺疾病(COPD)者的自身因素、手术因素与手术后肺部并发症(PPC)发生的关系及术前各项肺功能指标和动脉血氧分压(PaO2)与PPC的关系。方法对2002年9月至2004年11月中国医科大学附属第一医院重症医学科收治的54例围手术期COPD病人按年龄、体重指数(BMI)、手术时间及手术部位分别分组,对不同组间PPC的发生率进行χ2检验;利用SPSS11.12统计软件对术前动脉血氧分压(PaO2)和肺功能指标与PPC间的关系、对术前动脉血氧分压(PaO2)和肺功能指标与术后机械通气(MV)时间的关系进行多元相关分析。结果54例病人中30例(55.6%)发生PPC。年龄>70岁组与年龄≤70岁组的PPC发生率差异无显著性意义;BMI≥24组的PPC发生率显著高于BMI<24组;手术时间≥2h组的PPC发生率显著高于<2h组;上腹部手术组PPC的发生率显著高于下腹部组。术前PaO2和各肺功能指标与PPC的发生呈负相关趋势;而肺通气功能的各项指标与术后机械通气(MV)时间也呈负相关趋势。结论围手术期COPD病人,BMI≥24、手术时间≥2h者,上腹部手术者,术前肺通气功能较差者,PPC的发生率高;术前阻塞性肺通气功能障碍越重,MV时间越长。
Objective To analyze the factors of perioperative patients with chronic obstructive pulmonary disease (COPD), the relationship between operative factors and postoperative pulmonary complications (PPC) and the preoperative pulmonary function indexes and arterial partial pressure of oxygen (PaO2 ) And PPC relationship. Methods 54 patients with perioperative COPD admitted to the First Affiliated Hospital of China Medical University from September 2002 to November 2004 were divided into groups according to age, body mass index (BMI), operation time and operation site, The incidence of PPC between the χ2 test; the use of SPSS11.12 statistical software preoperative arterial partial pressure of oxygen (PaO2) and pulmonary function parameters and the relationship between PPC, preoperative arterial oxygen tension (PaO2) and pulmonary function Index and postoperative mechanical ventilation (MV) time relationship between the multivariate correlation analysis. Results PPC occurred in 30 of 54 patients (55.6%). There was no significant difference in the incidence of PPC between the age group of> 70 years and the group of ≤70 years of age. The incidence of PPC in the group of BMI≥24 was significantly higher than that in the BMI group (<24). The incidence of PPC was significantly higher in the group of> 2h group. The incidence of PPC in upper abdominal surgery group was significantly higher than that in lower abdominal group. There was a negative correlation between preoperative PaO2 and pulmonary function parameters and the occurrence of PPC. However, the indexes of pulmonary ventilation function and the duration of postoperative mechanical ventilation (MV) also showed a negative correlation trend. Conclusions Perioperative COPD patients, BMI ≥ 24, operation time ≥ 2h, upper abdominal surgery, preoperative pulmonary ventilation poor performance, PPC high incidence; preoperative obstructive pulmonary dysfunction more severe, MV time The longer.