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目的:探讨食管癌、贲门癌术后发生急性呼吸衰竭(acute respiratory failure,ARF)的危险因素,为针对性预防其发生提供临床指导依据。方法:将1995年1月~2005年1月期间食管癌、贲门癌术后发生ARF的42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ARF的84例食管癌、贲门癌患者的资料做对照,应用Logistic回归分析比较两组患者的年龄、性别、吸烟指数、术前肺功能、术前有无肺部合并症和其它合并症、术前有无低蛋白血症、吻合口位置、手术时间、术后是否镇痛、术后有无其它并发症等与术后发生ARF的相关强度,推测可能导致术后ARF发生的危险因素。结果:患者术前肺功能中重度受损、吸烟指数>400支/年、术前有肺部合并症和手术时间>3h,四个因素与术后ARF发生有显著相关性(P<0.05)。结论:术前改善低肺功能、早期戒烟、积极治疗肺部合并症、提高手术技巧,缩短手术时间是预防和减少术后ARF发生的重要环节之一。
Objective: To investigate the risk factors of postoperative acute respiratory failure (ARF) in esophageal and cardia cancer and provide clinical guidance for the prevention of their occurrence. Methods: The clinical data of 42 patients with ARF after esophageal cancer and cardia cancer surgery from January 1995 to January 2005 were compared with 84 patients with esophageal cancer, According to the data of patients with cardia cancer, Logistic regression analysis was used to compare the age, gender, smoking index, preoperative pulmonary function, preoperative pulmonary complications and other complications, preoperative hypoproteinemia , Anastomotic location, operation time, postoperative analgesia, postoperative complications and other ARF related intensity occurred after surgery, suggesting that may lead to postoperative ARF risk factors. Results: Preoperative pulmonary function was moderately and severely impaired, smoking index> 400 / year, preoperative pulmonary complications and operation time> 3h, there was significant correlation between four factors and postoperative ARF (P <0.05) . Conclusion: Preoperative to improve low lung function, early smoking cessation, aggressive treatment of pulmonary complications, improve surgical skills, shorten the operation time is to prevent and reduce postoperative ARF an important part.