發(fā)布時間：2018-04-07 15:04

  本文選題：肺癌　切入點：肺葉切除術　出處：《廣西醫(yī)科大學》2014年碩士論文

【摘要】：目的：通過探討影響肺癌患者行肺葉切除術后發(fā)生拔管延遲的因素。尋找縮短肺癌患者術后機械通氣時間的方法,進一步減少術后并發(fā)癥的發(fā)生和住院時間. 方法：采用回顧性調(diào)查方法，收集廣西腫瘤醫(yī)院2008年10月～2013年10月間因肺癌在全麻下實施肺葉切除手術患者的臨床資料，共收集706例患者資料，，男455例，女251例；年齡22～82歲，平均55歲，其中左肺411例，右肺295例。記錄患者一般情況、術前檢查、術中和術后管理等相關因素，單因素采用t檢驗、卡方檢驗或秩和檢驗分析數(shù)據(jù)，多因素采用非條件Logistic回歸模型分析方法（LR法）分析與拔管延遲發(fā)生率之間的關系。根據(jù)是否發(fā)生拔管延遲，分為正常拔管組和延遲拔管組。記錄兩組術后并發(fā)癥的發(fā)生率和住院時間。分析拔管延遲與術后并發(fā)癥、住院時間的關系。選擇2013年11月～2014年3月間24例擇期行肺葉切除術的肺癌患者，行雙腔支氣管插管麻醉，根據(jù)術前不同肺功能分為肺功能正常組和肺功能異常組（每組12例），記錄兩組的術后拔管時間，并發(fā)癥發(fā)生率以及住院時間，分析術前肺功能與術后拔管時機、并發(fā)癥以及住院時間的關系。 結果：全組術后發(fā)生拔管延遲51例，發(fā)生率為7.2%。延遲拔管組和正常拔管組術后并發(fā)癥的發(fā)生率分別為35.3%（18/51）和15.6%(102/655)，拔管延遲組的患者術后并發(fā)癥的發(fā)生率明顯高于正常拔管組,差異有統(tǒng)計學意義(P＜0.05)。延遲拔管組組和正常拔管組的平均住院時間分別為（17.5±6.2）d和（14.1±7.3）d,延遲拔管組的患者住院時間明顯長于正常拔管組，差異有統(tǒng)計學意義(P＜0.05)單因素分析中，有7個因素與開胸行肺葉切除術術后拔管延遲相關（P＜0.05)，分別是年齡，吸煙情況，術前合并癥，體重指數(shù)，單肺時間，術前白蛋白，術前肺功能。非條件Logistic回歸分析提示5個獨立危險因素：年齡＞60歲(OR=6.568，P＜0.001)，長時間單肺通氣(OR=1.268，P=0.047)，男性(OR=1.511，P=0.046)，尿量＜17ml/h(OR=1.456，P=0.032)，術前肺功能損傷(OR=1.579，P=0.033)。肺功能異常組和肺功能正常組術后拔管時間分別為（190±33）min和(103.9±17) min，肺功能異常組的患者術后帶管時間明顯久于肺功能正常組,差異有統(tǒng)計學意義(P＜0.05)。肺功能異常組和肺功能正常組術后并發(fā)癥的發(fā)生率分別為66.7%（8/12）和16.7%(2/12)，肺功能異常組的患者術后并發(fā)癥的發(fā)生率明顯高于肺功能正常組,差異有統(tǒng)計學意義(P＜0.05)。肺功能異常組和肺功能正常組的平均住院時間分別為（29±5）d和（23±2.3）d,肺功能異常組的患者住院時間明顯長于肺功能正常組，差異有統(tǒng)計學意義(P＜0.05) 結論：肺癌患者行肺葉切除術術后拔管延遲會增加術后住院時間和并發(fā)癥發(fā)生；發(fā)生術后拔管延遲是多因素協(xié)同作用引起的，主要與患者術前較差的肺功能、老年的男性病人、尿量、單肺通氣時間長等多種因素相關。術前肺功能異常的患者會顯著延長術后的帶管時間和住院時間，并具有較高的術后并發(fā)癥發(fā)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.
緇撴灉錛氬叏緇勬湳鍚庡彂鐢熸嫈綆″歡榪

本文編號：1719683