摘要
术后肺部并发症(PPC)是术后最常见的并发症之一.2018年的专家共识指出PPC是一系列具有共同病理生理机制的呼吸道疾病,包括肺不张、肺炎、急性呼吸窘迫综合征和肺误吸.根据加泰罗尼亚外科患者呼吸风险预测模型,PPC发生率在低危患者中为1％～3％、中危患者中为6％～13％、高危患者中为38％～45％.PPC的发生对患者的近远期预后均有负面影响.短期内,PPC不仅延长住院时间、增加医疗费用,还显著提高了围手术期死亡率和再入院率;长期看,PPC伴随5年生存率降低、肿瘤复发增加和非恶性呼吸系统疾病死亡风险增加.PPC的危险因素包括患者自身的基础健康状况和生活习惯(如吸烟)、手术类型和围手术期管理等.预防措施如戒烟、术前预康复和使用微创手术技术等可降低PPC发生率,但对长期预后的影响有待进一步研究.
Abstract
Postoperative pulmonary complication(PPC)is one of the most common postoperative complication.The expert consensus of 2018 pointes out that PPC is a series of respiratory diseases with common pathophysiological mechanisms,including atelectasis,pneumonia,acute respiratory distress syndrome and lung aspiration.According to Catalan surgical patient respiratory risk prediction model,the incidence rate of PPC is 1％to 3％in low-risk patients,6％to 13％in moderate-risk patients,and 38％to 45％in high-risk patients.The occurrence of PPC has a negative impact on short-term and long-term prognosis of patients.In short term,PPC not only prolongs hospitalization time and increases medical expenses,but also significantly increases perioperative mortality and readmission rates.In long run,PPC is associated with a decrease in five-year survival rate,an increase in tumor recurrence,and an increased risk of death from non malignant respiratory diseases.The risk factors for PPC include the patient's underlying health status and lifestyle habits(such as smoking),type of surgery and perioperative management.Preventive measures such as smoking cessation,preoperative rehabilitation and the use of minimally invasive surgical techniques can reduce the incidence rate of PPC,but their impact on long-term prognosis needs further research.
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