气道管理新进展

14.2%
10.3% 5.1% 1.8%
43
6 5 2
Multiple studies show the high incidence of postoperative pulmonary complications. 多项研究先提示术后肺部并发症的发生率较高。
1. Smetana et al. Ann Intern Med. 2006;144:581-95.
Disclosure
Mark Procyshyn, RRT is the Senior Regional Marketing Manager for Covidien’s Respiratory Division in Asia.
Outline:
What are postoperative pulmonary complications? 何为术后肺部并发症 What is their significance in terms of:
– Incidence? 发生率？ – Clinical outcomes? 临床结果？
Postoperative Pulmonary Байду номын сангаасomplications 术后肺部并发症
• These complications range from minor, self-limited conditions to major disease states with significant morbidity and mortality. 这些并发症小至自限性疾病，大至具有较高发病率和死亡率的疾病。 • The most commonly cited examples in the clinical literature are:1 在医学文献中最常见引用的并发症是：
– Pneumonia 肺炎 – Respiratory failure 呼吸衰竭 – Atelectasis 肺不张 – Acute exacerbation of chronic lung disease 慢性肺部疾病的急性加重
• Other prominent examples include ARDS, bronchospasm, tracheobronchitis and perioperative hypoxia.
Surgical site AAA repair 腹主动脉瘤切除术 Esophagectomy 食道切除术 Reported complication rate 25.5% 18.9% Studies, n 16 11
Abdominal surgery 腹部手术
Head and neck surgery 头颈部手术 Hip surgery 髋部手术 Gynecologic/Urologic procedures 妇科/泌尿科操作
– Incidence? 发生率？ – Clinical outcomes?
Postoperative Pulmonary Complications Are Surprisingly Common 术后肺部并发症十分常见
Summary of studies investigating incidence of postoperative pulmonary complications by surgical site, as per systematic literature review in 20061 2006年不同部位外科手术后术后肺部并发症发生率研究的概要
* Definite or probable MI, emergency cardioversion, pacemaker insertion, ventricular fibrillation, ventricular tachycardia, hypotension requiring vasopressors, sick sinus syndrome or other conduction defect, or CPR. † Respiratory failure or pneumonia.
其他突出的并发症包括：ARDS，支气管痉挛，支气管炎，术中低氧血症
1. Arozullah et al. Ann Surg. 2000;232(2):242-253.
Outline:
What are postoperative pulmonary complications?何为术后肺部并发症
What is their significance in terms of:
1. Lawrence et al. Arch Intern Med. 2002.
In Aggregate, Postoperative Pulmonary Complications Occur More Often Than Cardiac 总体上，术后肺部并发症多于心脏并发症
Serious cardiac* 严重的心血管疾病
Serious pulmonary† 严重的肺部疾病 p-value:
No statistical difference found for incidence or mortality at 30 days and 1 year. 30天或1年的发病率或死亡率无显著性差异。
Postoperative Pulmonary Complications Deserve Equal Attention with Perioperative Cardiac Complications 术后肺部并发症应与术中心脏并发症一样引起重视
Retrospective multicenter cohort study of 8,930 patients 60 years or older for hip surgery1 针对8930例60岁以上髋部手术患者的多中心回顾性队列研究， Complication Incidence 2.0% 2.6% 30-day mortality 22% 17% > 0.05 1-year mortality 36% 44% > 0.05