本文選題：腹腔鏡胰十二指腸切除術(shù) + 肺部并發(fā)癥��； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：腹腔鏡胰十二指腸切除術(shù)(Laparoscopic Pancreaticoduodenectomy,LPD)是腹部外科最大的手術(shù),術(shù)后并發(fā)癥發(fā)生率高,病死率高。自1992年國(guó)外實(shí)施第一例LPD后,經(jīng)過20多年的發(fā)展,其安全性和實(shí)用性已得到證實(shí)。我院肝膽外科腹腔鏡技術(shù)日趨成熟,2014年積極開展LPD,至今已實(shí)施全腔鏡下LPD逾200例,其技術(shù)水平位居國(guó)內(nèi)領(lǐng)先。腹腔鏡CO_2氣腹對(duì)呼吸系統(tǒng)影響大,LPD長(zhǎng)時(shí)間腹腔鏡手術(shù)操作極易出現(xiàn)肺部感染、肺不張等術(shù)后肺部相關(guān)并發(fā)癥;擬行此術(shù)式的患者多為老年人,呼吸系統(tǒng)生理功能改變明顯,通氣儲(chǔ)備下降,使得LPD患者術(shù)后肺部并發(fā)癥(Postoperative Pulmonary Complications,PPCs)發(fā)生風(fēng)險(xiǎn)增高。通過查閱文獻(xiàn),針對(duì)該術(shù)式患者PPCs的研究少有報(bào)道。本研究主要通過對(duì)接受LPD患者的臨床資料進(jìn)行回顧性分析,對(duì)其術(shù)前、術(shù)中及術(shù)后臨床資料相關(guān)數(shù)據(jù)進(jìn)行統(tǒng)計(jì)處理,得到結(jié)果并加以分析,最終總結(jié)LPD患者PPCs的高危因素,為臨床長(zhǎng)時(shí)間腹腔鏡手術(shù)的麻醉管理提供參考。目的:回顧性分析LPD患者圍術(shù)期相關(guān)資料,探討LPD患者PPCs高危因素,以期進(jìn)一步優(yōu)化LPD圍術(shù)期麻醉管理,降低PPCs發(fā)生率。方法:對(duì)2015年10月-2017年1月在河北醫(yī)科大學(xué)第二醫(yī)院肝膽外科行擇期LPD的100例患者的臨床資料進(jìn)行回顧性分析,按術(shù)后是否發(fā)生肺部并發(fā)癥分為肺部并發(fā)癥組和非肺部并發(fā)癥組,記錄并比較兩組患者圍術(shù)期相關(guān)資料:性別、年齡、BMI值、ASA分級(jí)、吸煙史、慢性阻塞性肺疾患(COPD)、高血壓、糖尿病、冠心病、肝功能分級(jí)、吸入氧濃度(FiO_2)、術(shù)中輸血、術(shù)中輸液量、術(shù)中保溫、術(shù)中應(yīng)用烏司他丁、術(shù)后鎮(zhèn)痛、ICU留觀、手術(shù)時(shí)長(zhǎng)、術(shù)后住院時(shí)長(zhǎng)共19個(gè)變量信息,其中對(duì)單因素分析結(jié)果中有方差差異的變量行Logistic回歸多因素分析。結(jié)果:1分析100例LPD患者臨床資料,確診發(fā)生PPCs者33例,其發(fā)生率為33%。2單因素分析結(jié)果顯示:肺部并發(fā)癥組吸煙史、COPD、100%FiO_2、術(shù)中應(yīng)用烏司他丁、留觀ICU發(fā)生率分別為:30.3%、33.3%、84.8%、9.1%、66.7%,非肺部并發(fā)癥組分別為:19.4%、14.9%、50.7%、29.9%、17.9%,以上五項(xiàng)變量?jī)山M比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。3 t檢驗(yàn)結(jié)果:肺部并發(fā)癥組年齡(63.30±8.33)歲,術(shù)后住院時(shí)長(zhǎng)(29.91±20.89)天,非肺部并發(fā)癥組年齡(58.16±9.52)歲,術(shù)后住院時(shí)長(zhǎng)(19.30±8.18)天,以上兩項(xiàng)變量?jī)山M比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。4將以上差異有統(tǒng)計(jì)學(xué)意義的7個(gè)變量進(jìn)行Logistic多因素回歸分析,結(jié)果3個(gè)變量進(jìn)入最終回歸方程:吸煙史(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)為L(zhǎng)PD患者術(shù)后發(fā)生肺部并發(fā)癥的高危因素。結(jié)論:術(shù)前有吸煙史、合并COPD病史、術(shù)中麻醉期間100%FiO_2為L(zhǎng)PD患者PPCs發(fā)生的高危因素,針對(duì)這些因素進(jìn)行干預(yù)或許能降低LPD患者PPCs的發(fā)生可能;術(shù)前無吸煙史、不合并COPD病史、合適的Fi O_2顯著縮短LPD患者術(shù)后住院時(shí)長(zhǎng),利于患者術(shù)后康復(fù)。
[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 鹵8.33) years, and the length of hospital stay was (29.91 鹵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 鹵8.33) years old, and the length of hospital stay was (29.91 鹵20.89) days after operation. The age of non-pulmonary complication group was (58.16 鹵9.52) years old, and the length of hospitalization was (19.30 鹵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.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R614

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