术中液体入量速度对肺切除术后患者肺部并发症的影响

doi:10.3877/cma.j.issn.2095-8773.2017.03.05

目的

探讨术中液体入量速度对肺手术患者术后肺部并发症的影响。

方法

回顾性分析2017年1月1日—3月15日在浙江大学医学院附属第一医院行解剖性肺切除术的患者125例，有效纳入病例98例，按术中液体入量速度分为低滴速组(液体入量速度<7.5 ml·kg^－¹·h^－¹，n＝35)、中滴速组(液体入量速度7.5～10.5 ml·kg^－¹·h^－¹，n＝40)和高滴速组(液体入量速度>10.5 ml·kg^－¹·h^－¹，n＝23)。比较三组患者术后肺部并发症发生率、住院天数和院内病死率的差异。

结果

低滴速组、中滴速组和高滴速组患者术后肺部并发症发生率分别为45.7%(16/35)、20.0%(8/40)和43.5%(10/23)，中滴速组并发症发生率显著低于其他两组，差异有统计学意义(P>0.05)。三组患者术后均无死亡病例，三组间术后平均住院天数比较差异也无统计学意义(P>0.05)。

结论

在行解剖性肺切除术时，术中液体入量速度控制在7.5～10.5 ml·kg^－1·h^－1有助于减少患者肺部并发症的发生，应引起胸外科医生和麻醉医师的足够重视与关注。

关键词: 肺切除术, 液体入量速度, 肺部并发症

Objective

To study the effect of the intraoperative infusion rate of fluids on postoperative pulmonary complications in patients who went under pneumonectomy.

Methods

A retrospective study was conducted on 125 patients with anatomic pneumonectomy from January 1 to March 15, 2017 at the First Affiliated Hospital, College of Medicine, Zhejiang University. 98 cases were effectively included and were divided into three groups according the intraoperative infusion rate of fluids: low infusion rate group (<7.5 ml·kg^-1·h^-1, n=35), medium infusion rate group (7.5-10.5 ml·kg^-1·h^-1, n=40) high infusion rate group (> 10.5 ml·kg^-1·h^-1, n=23). The incidence of postoperative pulmonary complications, hospital stay and hospital mortality were compared between the three groups.

Results

The incidence of pulmonary complications in each group was 45.7% (16/35) in the low infusion rate group, 20.0% (8/40) in the medium infusion rate group and 43.5% (10/23) in the high infusion rate group. The incidence of postoperative pulmonary complications was significantly lower in the medium infusion rate group than in the low infusion rate group and the high infusion rate group (P<0.05). No death cases were found in the three groups. There was no significant difference in the average length of hospital stay between the three groups (P>0.05).

Conclusions

In the course of anatomic pneumonectomy, the intraoperative infusion rate of fluids controlled at 7.5-10.5 ml·kg-1 ·h^-1 can help to reduce the incidence of postoperative pulmonary complications in patients, which should cause the thoracic surgeons and anesthesiologists to pay enough attention.

Key words: Pneumonectomy, Infusion rate of fluid, Pulmonary complication

表1 不同术中液体入量速度患者基本资料比较(±s)

一般特征		低滴速组(n＝35)	中滴速组(n＝40)	高滴速组(n＝23)	检验值	P值
性别[n(%)]		?	?	?	χ²＝2.990	0.224
?	男性	19(54.3)	15(37.5)	13(56.5)	?	?
?	女性	16(45.7)	25(62.5)	10(43.5)	?	?
年龄(岁，±s)		57.3±9.6	57.2±7.3	61.4±6.0	F＝2.400	0.096
吸烟量(包-年，±s)		16.3±26.3	7.3±17.7	21.1±44.5	F＝1.896	0.156
肺切除类型[n(%)]		?	?	?	χ²＝4.689	0.096
?	肺叶	31(88.6)	39(97.5)	23(100)	?	?
?	肺段	4(11.4)	1(2.5)	0(0)	?	?
术中出血量(ml，±s)		49.4±24.5	44.3±25.7	43.0±22.9	F＝0.603	0.549
术中尿量(ml，±s)		357.1±357.6	419.2±409.6	223.0±155.9	F＝2.286	0.108
手术时间(min，±s)		128.7±27.4	131.1±29.7	114.3±29.4	F＝2.676	0.074
病理类型[n(%)]		?	?	?	χ²＝1.715	0.424
?	肺癌	33(94.3)	34(85.0)	20(87.0)	?	?
?	良性疾病	2(5.7)	6(15.0)	3(13.0)	?	?

表1 不同术中液体入量速度患者基本资料比较(±s)

一般特征		低滴速组(n＝35)	中滴速组(n＝40)	高滴速组(n＝23)	检验值	P值
性别[n(%)]		?	?	?	χ²＝2.990	0.224
?	男性	19(54.3)	15(37.5)	13(56.5)	?	?
?	女性	16(45.7)	25(62.5)	10(43.5)	?	?
年龄(岁，±s)		57.3±9.6	57.2±7.3	61.4±6.0	F＝2.400	0.096
吸烟量(包-年，±s)		16.3±26.3	7.3±17.7	21.1±44.5	F＝1.896	0.156
肺切除类型[n(%)]		?	?	?	χ²＝4.689	0.096
?	肺叶	31(88.6)	39(97.5)	23(100)	?	?
?	肺段	4(11.4)	1(2.5)	0(0)	?	?
术中出血量(ml，±s)		49.4±24.5	44.3±25.7	43.0±22.9	F＝0.603	0.549
术中尿量(ml，±s)		357.1±357.6	419.2±409.6	223.0±155.9	F＝2.286	0.108
手术时间(min，±s)		128.7±27.4	131.1±29.7	114.3±29.4	F＝2.676	0.074
病理类型[n(%)]		?	?	?	χ²＝1.715	0.424
?	肺癌	33(94.3)	34(85.0)	20(87.0)	?	?
?	良性疾病	2(5.7)	6(15.0)	3(13.0)	?	?

表2 不同术中液体入量速度对术后肺部并发症和住院天数的影响(±s)

组别		输入液体总量(ml)	体重(kg)	麻醉持续时间(min)	液体入量速度(ml·kg^－1·h^－1)	肺部并发症发生率[n(%)]	术后住院天数(d)
低滴速组(35例)^①		1 135.7±299.2	65.2±6.4	170.1±32.5	6.2±1.0	16(45.7)	5.3±1.6
中滴速组(40例)^②		1 512.5±282.8	61.1±8.2	168.0±32.4	9.0±0.8	8(20.0)	5.2±1.8
高滴速组(23例)^③		1 728.3±319.0	57.7±6.9	143.4±27.7	12.8±1.9	10(43.5)	5.7±2.1
①与②比较		?	?	?	?	?	?
?	检验值	t＝－5.4743	t＝2.4051	t＝0.2932	t＝－9.9419	χ²＝5.672	t＝0.4530
?	P值	<0.001	0.018	0.770	<0.001	0.017	0.652
①与③比较		?	?	?	?	?	?
?	检验值	t＝＝－7.4235	t＝3.8384	t＝3.1566	t＝－20.2055	χ²＝0.028	t＝＝－0.8026
?	P值	<0.001	<0.001	0.002	<0.001	0.867	0.424
②与③比较		?	?	?	?	?	?
?	检验值	t＝－2.7727	t＝1.8099	t＝2.9786	t＝－11.9322	χ²＝3.944	t＝－1.2239
?	P值	0.007	0.073	0.004	<0.001	0.047	0.224

表2 不同术中液体入量速度对术后肺部并发症和住院天数的影响(±s)

组别		输入液体总量(ml)	体重(kg)	麻醉持续时间(min)	液体入量速度(ml·kg^－1·h^－1)	肺部并发症发生率[n(%)]	术后住院天数(d)
低滴速组(35例)^①		1 135.7±299.2	65.2±6.4	170.1±32.5	6.2±1.0	16(45.7)	5.3±1.6
中滴速组(40例)^②		1 512.5±282.8	61.1±8.2	168.0±32.4	9.0±0.8	8(20.0)	5.2±1.8
高滴速组(23例)^③		1 728.3±319.0	57.7±6.9	143.4±27.7	12.8±1.9	10(43.5)	5.7±2.1
①与②比较		?	?	?	?	?	?
?	检验值	t＝－5.4743	t＝2.4051	t＝0.2932	t＝－9.9419	χ²＝5.672	t＝0.4530
?	P值	<0.001	0.018	0.770	<0.001	0.017	0.652
①与③比较		?	?	?	?	?	?
?	检验值	t＝＝－7.4235	t＝3.8384	t＝3.1566	t＝－20.2055	χ²＝0.028	t＝＝－0.8026
?	P值	<0.001	<0.001	0.002	<0.001	0.867	0.424
②与③比较		?	?	?	?	?	?
?	检验值	t＝－2.7727	t＝1.8099	t＝2.9786	t＝－11.9322	χ²＝3.944	t＝－1.2239
?	P值	0.007	0.073	0.004	<0.001	0.047	0.224

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Effect of the intraoperative infusion rate of fluids on postoperative pulmonary complications after pneumonectomy

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Effect of the intraoperative infusion rate of fluids on postoperative pulmonary complications after pneumonectomy