本文選題：肺癌　切入點(diǎn)：肺葉切除術(shù)　出處：《廣西醫(yī)科大學(xué)》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(shù)后發(fā)生拔管延遲的因素。尋找縮短肺癌患者術(shù)后機(jī)械通氣時(shí)間的方法,進(jìn)一步減少術(shù)后并發(fā)癥的發(fā)生和住院時(shí)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(shí)施肺葉切除手術(shù)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(shù)前檢查、術(shù)中和術(shù)后管理等相關(guān)因素，單因素采用t檢驗(yàn)、卡方檢驗(yàn)或秩和檢驗(yàn)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(guān)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(shù)后并發(fā)癥的發(fā)生率和住院時(shí)間。分析拔管延遲與術(shù)后并發(fā)癥、住院時(shí)間的關(guān)系。選擇2013年11月～2014年3月間24例擇期行肺葉切除術(shù)的肺癌患者，行雙腔支氣管插管麻醉，根據(jù)術(shù)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(shù)后拔管時(shí)間，并發(fā)癥發(fā)生率以及住院時(shí)間，分析術(shù)前肺功能與術(shù)后拔管時(shí)機(jī)、并發(fā)癥以及住院時(shí)間的關(guān)系。 結(jié)果：全組術(shù)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(shù)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(shù)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(jì)學(xué)意義(P＜0.05)。延遲拔管組組和正常拔管組的平均住院時(shí)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(shí)間明顯長(zhǎng)于正常拔管組，差異有統(tǒng)計(jì)學(xué)意義(P＜0.05)單因素分析中，有7個(gè)因素與開胸行肺葉切除術(shù)術(shù)后拔管延遲相關(guān)（P＜0.05)，分別是年齡，吸煙情況，術(shù)前合并癥，體重指數(shù)，單肺時(shí)間，術(shù)前白蛋白，術(shù)前肺功能。非條件Logistic回歸分析提示5個(gè)獨(dú)立危險(xiǎn)因素：年齡＞60歲(OR=6.568，P＜0.001)，長(zhǎng)時(shí)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(shù)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(shù)后拔管時(shí)間分別為（190±33）min和(103.9±17) min，肺功能異常組的患者術(shù)后帶管時(shí)間明顯久于肺功能正常組,差異有統(tǒng)計(jì)學(xué)意義(P＜0.05)。肺功能異常組和肺功能正常組術(shù)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(shù)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(jì)學(xué)意義(P＜0.05)。肺功能異常組和肺功能正常組的平均住院時(shí)間分別為（29±5）d和（23±2.3）d,肺功能異常組的患者住院時(shí)間明顯長(zhǎng)于肺功能正常組，差異有統(tǒng)計(jì)學(xué)意義(P＜0.05) 結(jié)論：肺癌患者行肺葉切除術(shù)術(shù)后拔管延遲會(huì)增加術(shù)后住院時(shí)間和并發(fā)癥發(fā)生；發(fā)生術(shù)后拔管延遲是多因素協(xié)同作用引起的，主要與患者術(shù)前較差的肺功能、老年的男性病人、尿量、單肺通氣時(shí)間長(zhǎng)等多種因素相關(guān)。術(shù)前肺功能異常的患者會(huì)顯著延長(zhǎng)術(shù)后的帶管時(shí)間和住院時(shí)間，并具有較高的術(shù)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(hào)：1719683