目的 探討肥胖對(duì)肺切除術(shù)后并發(fā)癥發(fā)生和手術(shù)死亡率的影響?!》椒ā』仡櫺苑治?003年9月至2007年12月上海市肺科醫(yī)院3 494例肺部疾病行肺切除術(shù)患者的臨床資料,依據(jù)體重指數(shù)(body mass index,BMI)不同將3 494例患者分為兩組,非肥胖組(BMI<28 kg/m2):3 340例,男2 502例,女838例;年齡(61.9±10.7)歲;肥胖組(BMI≥28 kg/m2):154例,男87例,女67例;年齡(59.7±9.6)歲。通過(guò)單因素和logistic多因素回歸分析肥胖(BMI≥28 kg/m2)對(duì)肺切除術(shù)后并發(fā)癥發(fā)生的影響?!〗Y(jié)果 圍術(shù)期共死亡26例,其中非肥胖組死亡23例,肥胖組死亡3例,兩組患者的病死率比較差異無(wú)統(tǒng)計(jì)學(xué)意義[0.7% (23/3 340) vs. 1.9% (3/154),P=0.118]。兩組患者任一并發(fā)癥和呼吸系統(tǒng)并發(fā)癥發(fā)生率比較差異均無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05)。除呼吸系統(tǒng)外,肥胖組患者其它系統(tǒng)并發(fā)癥發(fā)生率顯著高于非肥胖組(P<0.05),腦血管意外、心肌梗死和急性腎功能衰竭發(fā)生率高于非肥胖組(P<0.05)。Logistic多因素回歸分析結(jié)果顯示:肥胖(BMI≥28 kg/m2)不是肺切除術(shù)后并發(fā)癥發(fā)生的獨(dú)立危險(xiǎn)因素[回歸系數(shù)為0.648、OR值為1.911,95% CI (0.711,5.138),P值為0.199]?!〗Y(jié)論 肥胖不引起肺切除術(shù)后手術(shù)死亡率和并發(fā)癥發(fā)生率的顯著增高。
引用本文: 宋楠,姜格寧,王海峰,劉明,何文新,張鵬,丁嘉安. 肥胖對(duì)肺切除術(shù)后并發(fā)癥發(fā)生的影響. 中國(guó)胸心血管外科臨床雜志, 2013, 20(1): 74-78. doi: 復(fù)制
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3. | 雷藝炎, 陳振光, 羅紅鶴, 等. 肺癌患者圍術(shù)期并發(fā)癥發(fā)生的危險(xiǎn)因素分析. 中國(guó)胸心血管外科臨床雜志, 2008, 15 (4):268-271. |
4. | 王邵華, 阮征, 鄭健, 等. 肺切除術(shù)后肺部并發(fā)癥發(fā)生的危險(xiǎn)因素分析. 中國(guó)胸心血管外科臨床雜志, 2010, 17 (4):301-306. |
5. | 馬柱, 李德生, 阿不都艾尼?吐?tīng)柡椋?等. 生理學(xué)和手術(shù)侵襲度評(píng)分在肺癌手術(shù)風(fēng)險(xiǎn)預(yù)測(cè)中的應(yīng)用. 中國(guó)胸心血管外科臨床雜志, 2012, 19 (1):31-35. |
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8. | Menna C, Ciccone AM, Ibrahim M, et al. Pneumonectomy:quality of life and long-term results. Minerva Chir, 2012, 67 (3):219-226. |
9. | Licker M, Spiliopoulos A, Frey JG, et al. Risk factors for early mortality and major complications following pneumonectomy for non-small cell carcinoma of the lung. Chest, 2002, 121 (6):1890-1897. |
10. | Kanasky WF Jr, Anton SD, Rodrigue JR, et al. Impact of body weight on long-term survival after lung transplantation. Chest, 2002, 121 (2):401-406. |
11. | Heuer M, Kaiser GM, Kahraman A, et al. Liver transplantation in nonalcoholic steatohepatitis is associated with high mortality and post-transplant complications:a single-center experience. Digestion, 2012, 86 (2):107-113. |
12. | Lascano CA, Kaidar-Person O, Szomstein S, et al. Challenges of laparoscopic colectomy in the obese patient:a review. Am J Surg, 2006, 192 (3):357-365. |
13. | Porter SE, Russell GV, Dews RC, et al. Complications of acetabular fracture surgery in morbidly obese patients. J Orthop Trauma, 2008, 22 (9):589-594. |
14. | 李世寬, 周巖冰, 周成富, 等. 肥胖對(duì)胃癌患者術(shù)后短期結(jié)局的影響. 中華胃腸外科雜志, 2010, 13 (2):133-137. |
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21. | Ouellette DW, Patocka C. Pulmonary embolism. Emerg Med Clin North Am, 2012, 30 (2):329-375. |
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24. | Gargiulo NJ 3rd, Veith FJ, Lipsitz EC, et al. Experience with inferior vena cava filter placement in patients undergoing open gastric bypass procedures. J Vasc Surg, 2006, 44 (6):1301-1305. |
25. | Karunakar MA, Shah SN, Jerabek S. Body mass index as a predictor of complications after operative treatment of acetabular fractures. J Bone Joint Surg Am, 2005, 87 (7):1498-1502. |
- 1. 中華人民共和國(guó)疾病控制司. 中國(guó)成人超重和肥胖癥預(yù)防控制指南. 2003. 2.
- 2. 趙文華, 翟屹, 胡建平, 等. 中國(guó)超重和肥胖造成相關(guān)慢性疾病的經(jīng)濟(jì)負(fù)擔(dān)研究. 中華流行病學(xué)雜志, 2006, 27 (7):555-559.
- 3. 雷藝炎, 陳振光, 羅紅鶴, 等. 肺癌患者圍術(shù)期并發(fā)癥發(fā)生的危險(xiǎn)因素分析. 中國(guó)胸心血管外科臨床雜志, 2008, 15 (4):268-271.
- 4. 王邵華, 阮征, 鄭健, 等. 肺切除術(shù)后肺部并發(fā)癥發(fā)生的危險(xiǎn)因素分析. 中國(guó)胸心血管外科臨床雜志, 2010, 17 (4):301-306.
- 5. 馬柱, 李德生, 阿不都艾尼?吐?tīng)柡椋?等. 生理學(xué)和手術(shù)侵襲度評(píng)分在肺癌手術(shù)風(fēng)險(xiǎn)預(yù)測(cè)中的應(yīng)用. 中國(guó)胸心血管外科臨床雜志, 2012, 19 (1):31-35.
- 6. Myrdal G, Gustafsson G, Lambe M, et al. Outcome after lung cancer surgery. Factors predicting early mortality and major morbidity. Eur J Cardiothorac Surg, 2001, 20 (4):694-699.
- 7. Kalathiya RJ, Saha SP. Pneumonectomy for non-small cell lung Cancer:outcomes analysis. South Med J, 2012, 105 (7):350-354.
- 8. Menna C, Ciccone AM, Ibrahim M, et al. Pneumonectomy:quality of life and long-term results. Minerva Chir, 2012, 67 (3):219-226.
- 9. Licker M, Spiliopoulos A, Frey JG, et al. Risk factors for early mortality and major complications following pneumonectomy for non-small cell carcinoma of the lung. Chest, 2002, 121 (6):1890-1897.
- 10. Kanasky WF Jr, Anton SD, Rodrigue JR, et al. Impact of body weight on long-term survival after lung transplantation. Chest, 2002, 121 (2):401-406.
- 11. Heuer M, Kaiser GM, Kahraman A, et al. Liver transplantation in nonalcoholic steatohepatitis is associated with high mortality and post-transplant complications:a single-center experience. Digestion, 2012, 86 (2):107-113.
- 12. Lascano CA, Kaidar-Person O, Szomstein S, et al. Challenges of laparoscopic colectomy in the obese patient:a review. Am J Surg, 2006, 192 (3):357-365.
- 13. Porter SE, Russell GV, Dews RC, et al. Complications of acetabular fracture surgery in morbidly obese patients. J Orthop Trauma, 2008, 22 (9):589-594.
- 14. 李世寬, 周巖冰, 周成富, 等. 肥胖對(duì)胃癌患者術(shù)后短期結(jié)局的影響. 中華胃腸外科雜志, 2010, 13 (2):133-137.
- 15. Cooper L.Postoperative complications after thoracic surgery in the morbidly obese patient. Anesthesiol Res Pract, 2011, 865634.
- 16. Piestrzeniewicz K, Luczak K, Komorowski J, et al. The relationship between leptin and obesity and cardiovascular risk factors in men with acute myocardial infarction. Cardiol J, 2007, 14 (3):252-259.
- 17. Flegal KM, Carroll MD, Ogden CL, et al. Prevalence and trends in obesity among US adults, 1999-2000. JAMA, 2002, 288 (14):1723-1727.
- 18. Baskin ML, Ard J, Franklin F, et al. Prevalence of obesity in the United States. Obes Rev, 2005, 6 (1):5-7.
- 19. Wang Y, Beydoun MA.The obesity epidemic in the United States-gender, age, socioeconomic, racial/ethnic, and geographic characteristics:a systematic review and meta-regression analysis. Epidemiol Rev, 2007, 29:6-28.
- 20. Bruce W, Van der Wall H, Peters M, et al. Occurrence of pulmonary thromboembolism immediately after arthroplasty. Nucl Med Commun, 2001, 22 (11):1237-1242.
- 21. Ouellette DW, Patocka C. Pulmonary embolism. Emerg Med Clin North Am, 2012, 30 (2):329-375.
- 22. Goldhaber SZ, Bounameaux H. Pulmonary embolism and deep vein thrombosis. Lancet, 2012, 379 (9828):1835-1846.
- 23. Cushman M. Epidemiology and risk factors for venous thrombosis. Semin Hematol, 2007, 44 (2):62-69.
- 24. Gargiulo NJ 3rd, Veith FJ, Lipsitz EC, et al. Experience with inferior vena cava filter placement in patients undergoing open gastric bypass procedures. J Vasc Surg, 2006, 44 (6):1301-1305.
- 25. Karunakar MA, Shah SN, Jerabek S. Body mass index as a predictor of complications after operative treatment of acetabular fractures. J Bone Joint Surg Am, 2005, 87 (7):1498-1502.