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目的 探讨食管癌术后发生呼吸衰竭 (RF)的高危因素。 方法 将我院胸心外科 1985～ 1998年收治的食管癌术后发生 RF的 5 8例患者临床资料 ,与按 1∶ 2比例随机抽取的同期手术后未发生 RF的 116例食管癌患者的资料做对照 ,用 χ2检验比较两组患者的术前肺功能 ,术前、术后其它合并症 ,吻合口部位 ,手术当天静脉液体入量和患者年龄、吸烟量的差异 ,应用 L ogistic回归分析肺功能各异常指标与术后 RF发生的相关强度 ,推测可能导致食管癌术后 RF发生的高危因素。 结果 RF组的最大通气量 (MVV) ,残气容积 /肺总量比值 (RV/TL C) ,第一秒用力呼气容积 (FEV1 ) ,最大呼气流量 (PEF) ,75 %肺活量最大呼气流量 (V75 )以及肺一氧化碳弥散量明显差于对照组 (P<0 .0 1) ;手术当天 (含术中 )静脉晶体液入量和输血量明显高于对照组 (P<0 .0 1) ,RF组术后其它并发症发生率和颈部吻合率明显高于对照组 (P<0 .0 1)。 结论 术前肺功能提示重度慢性支气管炎、肺气肿及吻合口瘘等术后并发症是术后发生 RF的高危因素 ,对颈部吻合患者应加强呼吸功能监护 ,术中严密止血是预防术后 RF发生的重要环节之一。
Objective To investigate the risk factors for respiratory failure (RF) after esophageal cancer. Methods The clinical data of 58 cases of esophageal cancer after radiotherapy in thoracic surgery in our hospital from 1985 to 1998 were compared with those of 116 cases of esophageal cancer without RF after operation in the same period randomly selected in a ratio of 1:2. For comparison, the χ2 test was used to compare the preoperative lung function of the two groups, preoperative and postoperative comorbidities, anastomotic site, the difference between the venous fluid intake, the age of the patient, and the amount of smoking. L ogistic regression analysis was used to analyze the lungs. The correlation between the functional abnormalities and the postoperative RF occurrence is presumed to be a risk factor for the occurrence of postoperative RF in esophageal cancer. Results RF ventilation group (MVV), residual air volume/lung ratio (RV/TL C), forced expiratory volume in 1 second (FEV1), maximum expiratory flow (PEF), 75% maximum vital capacity call The volume of blood flow (V75) and the amount of carbon monoxide diffused in the lung were significantly worse than those in the control group (P<0.01). The amount of fluid and blood transfused into the vein on the day of surgery (including surgery) was significantly higher than that in the control group (P<0. 0 1) The incidence of other complications and neck anastomosis were significantly higher in the RF group than in the control group (P < 0.01). Conclusions Preoperative pulmonary function suggests that severe bronchitis, emphysema, anastomotic leakage, and other postoperative complications are risk factors for postoperative RF, and respiratory function monitoring should be strengthened in patients with neck anastomosis. Strict hemostasis during surgery is a preventive technique. One of the important links that occurred after the RF.