術(shù)前干預(yù)對腹部外科COPD病人肺部并發(fā)癥的影響
發(fā)布時(shí)間：2018-09-11 18:53
【摘要】：研究背景：隨著社會老齡化不斷加劇,外科病人中COPD (Chronic Obstructive Pulmonary Disease,慢性阻塞性肺疾病)患者日趨增多。COPD患者免疫及應(yīng)激能力低下,手術(shù)風(fēng)險(xiǎn)大,術(shù)后PPC (Postoperative Pulmonary Complications,術(shù)后肺部并發(fā)癥)等并發(fā)癥多,約占整個(gè)術(shù)后并發(fā)癥的40%。PPC的發(fā)生受諸多因素影響如年齡、手術(shù)部位、麻醉方式、手術(shù)時(shí)間及COPD嚴(yán)重程度等,術(shù)前合并COPD病人PPC發(fā)生率是正常人的20倍,常造成患者術(shù)后呼吸衰竭、切口裂開的并發(fā)癥,嚴(yán)重者死亡率明顯增加。目前對于圍手術(shù)期的COPD病人如何進(jìn)行PPC預(yù)防尚無明確的標(biāo)準(zhǔn),外科醫(yī)生對PPC的認(rèn)知不足,術(shù)后PPC發(fā)生率仍高達(dá)30%。如何正確的預(yù)防PPC的發(fā)生引起我們的高度重視。 目的：探討通過對圍手術(shù)期呼吸系統(tǒng)的管理,減少COPD病人PPC發(fā)生率。 方法：本文對2007年1月～2013年2月大連醫(yī)科大學(xué)附屬第二醫(yī)院普外科收治的圍手術(shù)期COPD患者病例進(jìn)行回顧性分析,對治療組和對照組PPC的發(fā)生率進(jìn)行比較分析。采用SPSS13.0軟件進(jìn)行數(shù)據(jù)處理,治療前后數(shù)據(jù)比較用配對t檢驗(yàn)；組間計(jì)數(shù)資料的比較用χ2檢驗(yàn),選擇檢驗(yàn)水平a=0.05,P0.05認(rèn)為有統(tǒng)計(jì)學(xué)差異明顯。 結(jié)果：治療組發(fā)生肺炎2例,發(fā)生率為7.6%(無呼吸衰竭),呼吸衰竭3例,發(fā)生率11.5%為(均無肺不張及肺炎)(表2)。對照組發(fā)生肺不張2例(發(fā)生率6.6%),發(fā)生肺炎6例(20%),呼吸衰竭5例(16.6%)。對照組發(fā)生切口裂開1例,經(jīng)換藥對癥治療后愈合。對照組其中1人術(shù)后因肺不張、肺炎、呼吸衰竭入ICU行呼吸機(jī)治療,兩組患者經(jīng)治療后均治愈出院,無死亡。治療組和對照組有顯著差異(P0.05)。COPD病人術(shù)前采取干預(yù)對于減少PPC發(fā)生非常重要。 結(jié)論：對COPD病人術(shù)前采取積極有效的綜合干預(yù)治療,能降低并發(fā)癥的發(fā)生,減少住院天數(shù),降低手術(shù)風(fēng)險(xiǎn)。
[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.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R656;R563.9
[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.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R656;R563.9
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