胸外科术后肺部并发症的研究进展
Journal: Basic Medical Theory Research DOI: 10.12238/bmtr.v7i3.14455
Abstract
在当今医疗领域,外科手术量持续攀升,围手术期管理水平亦不断提升。然而,术后肺部并发症(Postoperative Pulmonary Complications, PPCs)的发生率仍居高不下,尤其是在胸、腹部手术患者中,其发生率显著高于其他类型手术。目前,PPCs尚无完全统一的标准定义,但医学界普遍认可其涵盖以下至少一种呼吸系统病变：肺不张、肺炎、胸腔积液、气胸、急性呼吸窘迫综合征(ARDS)、肺动脉栓塞(PE)、支气管胸膜瘘、膈神经损伤及膈肌功能障碍等。PPCs已被公认为导致患者术后预后不良的关键因素,是增加术后病死率、延长住院时间及推高医疗费用的主要原因之一。本综述旨在整合近年来的研究文献,系统阐述当前关于PPCs危险因素的最新研究进展,深入探讨其防治策略,以期为该领域的深入研究及临床干预提供新的思路与方向。
Keywords
术后肺部并发症；预后；危险因素
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[5] 孙思琦,刘旭,王春红,等.60岁以上胸腔镜肺叶切除术患者术后肺部并发症现状及其预测模型研究[J].创伤与急危重病医学,2024,12(04):227-232.
[6] 陈丹丹,方婷婷,丁怡.胸腔镜肺叶切除术老年患者术前衰弱与术后肺部并发症的关系[J].中华麻醉学杂志,2021,41(8):928-932.
[7] 李岩,郅慧,王焕东.术前吸气肌训练对预防二尖瓣介入术患者术后肺部并发症及心肺功能的影响[J].青岛医药卫生,2024,56(03):203-206.
[8] 韦伊尔,冼乐武,符基定.老年肺癌患者行胸腔镜根治术后发生医院获得性肺炎的病原学特点及危险因素研究[J].中国医学创新,2023,20(19):164-168.
[9] 王朋飞,代伟娜,刘礼新,等.高体质量指数对胸腔镜下肺癌根治术围术期并发症及临床疗效的影响[J].肿瘤研究与临床,2019,31(03):167-171.
[10] 连娟琦,郑霞,陈代娣.187例肺癌术后患者肺部并发症预测研究[J].实用预防医学,2023,30(04):470-473.
[11] 孟迪,胡坚.术后肺部并发症现状[J].中国胸心血管外科临床杂志,2015,22(12):1085-1086.
[12] Miskovic A,Lumb A B.Postoperative pulmonary compli cations[J]. BJA: British Journal of Anaesthesia, 2017,118(3):317-334.
[13] Hausman MJ, Jewell ES, Engoren M. Regional versus gen eral anesthesia in surgical patients with chronic obstructive pulmonary disease: does avoiding general anesthesia reduce the risk of postoperative complications? Anesth Analg,2015,120(6):1405-1412.
[14] 哈盘·海依达尔,张存平.单腔、双腔气管插管对食管癌术后肺部并发症的影响[J].工企医刊,2014,27(6):1132-1133.
[15] Wang,Bing,et al."Risk factors for postoperative compl ications in patients with pulmonary tuberculosis."European Journal of Medical Research30.1(2025):1-13.
[16] Yang D, Grant M C, Stone A, et al. A meta-analysis of intraoperative ventilation strategies to prevent pulmonary complications: is low tidal volume alone sufficient to protect healthy lungs?[J]. Annals of surgery,2016,263(5):881-887.
[17] Levin M A,McCormick P J,Lin H M,et al.Low intraoperati ve tidal volume ventilation with minimal PEEP is associated with increased mortality[J].British journal of anaesthesia,2014,113(1):97-108.
[18] Severgnini,Paolo,et al."Protective mechanical ventila tion during general anesthesia for open abdominal surgery improves postoperative pulmonary function." Anesthesiology 118.6(2013):1307-1321.
[19] Futier E,Schmid W,Severgnini P,et al.Protective vers us conventional ventilation for surgery: a systematic review and individual patient data meta-analysis[J]. Anesthesiology,2015,123(1):00.
[20] Chandler D, Mosieri C,Kallurkar A, et al.Perioperative strategies for the reduction of postoperative pulmonary complications[J].Best practice & research Clinical anaesthesi ology,2020,34(2):153-166.
[21] Gracey D R, Divertie M B, Didier E P. Preoperative pulmonary preparation of patients with chronic obstructive pulmonary disease: a prospective study[J].Chest,1979,76(2):123-129.
[22] Kanat F,Golcuk A,Teke T,et al.Risk factors for postop erative pulmonary complications in upper abdominal surgery [J].ANZ journal of surgery,2007,77(3):135-141.
[23] Fisher B W, Majumdar S R,McAlister F A.Predicting pul monary complications after nonthoracic surgery: a systematic review of blinded studies[J].The American journal of medici ne,2002,112(3):219-225.
[24] Gunnarsson,L.,et al."Chronic obstructive pulmonary disease and anaesthesia: formation of atelectasis and gas exchange impairment."European Respiratory Journal4.9(1991):1106-1116.
[25] Wong J,Abrishami A,Matthew T,et al.Short-term preope rative smoking cessation and postoperative complications:a systematic review and meta-analysis[J].Canadian Journal of Anesthesia,2012,59(3):268.
[26] 费林晶,邹宓.胸腔镜部分肺切除术后肺部并发症的危险因素及对患者远期预后的影响 [J].反射疗法与康复医学,2024,5(22):110-113.
[27] 周青山,张玉,刘利,等.布托啡诺对胸腔镜手术后肺部并发症的影响[J].实用医院临床杂志,2024,21(04):119-123.
[28] 姚晗.腰硬联合麻醉与全身麻醉对老年患者髋部骨折手术术后肺部并发症的影响[D].湖北医药学院,2024.
[29] 闫效坤,吴庆华,陈少慕,等.术后引流量及肺功能预测值对非小细胞肺癌病人胸腔镜肺叶切除术后肺部并发症的预测价值[J].临床外科杂志,2023,31(09):848-851.
[30] 韩蔷,许瑞华,冯金华,等.围手术期全程肺康复训练对预防老年肝叶切除患者术后肺部并发症的效果研究[J].成都医学院学报,2023,18(03):325-328+348.
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