胸科手术麻醉临床资料回顾及荟萃分析

【作者】 陈肖东；

【导师】 黄冰；

【作者基本信息】 广西医科大学 ， 麻醉学， 2010， 硕士

【摘要】 第一章、胸科手术患者PACU滞留时间延长相关因素的非条件logistic回归分析目的:为探讨胸科手术病人在麻醉恢复室(post-anaesthesia care unit, PACU)滞留时间(从进入恢复室到送出恢复室)延长的危险因素,为胸科病人PACU滞留时间延长的病人的诊治提供理论依据和参考。方法:在麻醉档案室找出2004年8月份至2008年10月份的所有胸科手术病人的麻醉记录单,共得495例记录完善的病历。在麻醉记录单和胸科既往的电子医嘱上摘录所需的各项指标具体见表1。将所有病人的信息逐条输入建立一份Excel表格。再使用SPSS13.0软件包对数据进行单因素、多因素非条件logistic回归分析。结果:以PACU时间(Y)≧150min取值为1,Y<150min取值为0。495个病人中男:女=2.36(348/147),其中113例Y=1,总检出率为22.8%(113/495)。单因素及多因素分析结果提示引起病人PACU滞留时间延长的主要危险因素是年龄(OR=0.000)、手术方式(OR=0.094)、尿量(OR=0.000)、ASA分级(OR=0.004)、心血管活性药物使用(OR=0.002)共5项。结论:胸科病人麻醉后恢复室工作人员应对以上5项引起病人滞留时间延长的危险因素引起重视,应及时发现和处理相关问题。本文揭示的危险因素值得今后深入研究。第二章、胸科手术麻醉中单肺通气和双肺通气的安全性比较:a meta analysis目的系统评价胸科手术麻醉中单肺通气和双肺通气安全性。方法计算机检索Cochrane图书馆、Embase、PubMed和CBM,搜集所有非心脏手术的胸科手术麻醉中分组为单肺通气组和双肺通气组临床对照试验,按Cochrane系统评价的方法评价纳入研究质量,并使用RevMan 5.0软件对纳入研究进行Meta分析。结果最终纳入5个研究,包括3个RCT,1个非随机对照试验,1个回顾性试验。Mata分析结果显示,单肺通气组和双肺通气组与血气相关的并发症(包括低氧血症,高碳酸血症)[OR=0.68,95%CI【0.31-1.51】P=0.46]、与气管内插管相关的并发症(包括导管异位,肺分隔不良,声音嘶哑)[OR=153,95%CI【0.25-9.58】P=0.65]、循环系统并发症(包括血流动力学不稳定,心律失常)[OR=1.00,95%CI【0.17-6.05】,P=1.00]、呼吸系统并发症(包括肺炎,肺水肿,肺不张,ARDS)[OR=0.68,95%C【I0.31-1.51】P=0.35]差异无统计学意义。结论按现有证据单肺通气组和双肺通气组与血气相关的并发症、与气管内插管相关的并发症、循环系统并发症、呼吸系统并发症相似,但是血液系统并发症、外科并发症等尚不能判断,需要更多更好的临床试验来进一步证实。更多还原

【Abstract】 AN UNCONDITIONAL LOGISTIC REGRESSION ANALYSIS OF FACTORS OF PROLONGED PACU RETENTION TIME FOR THORACIC PATIENTSObjective: To explore the incidence and the possible risk factors which cause prolonged retention time at post-anesthetic care unit for patients undergoing thoracic surgeries and provide theoretical basis and references for future jobs dealing with such patients.Methods: In the archives room of anesthesia department, we searched out all the recording sheets of all the inpatients in thoracic department who underwent operations. We got in total 495 cases which were well recorded. Extract all useful data from anesthesia recording sheets and previous electronic medical records. For details see sheet 1. We typed in each piece of information extracted one by one and established an Excel form. Analysis of univariate and multivariate unconditional logistic regression was taken with the use of SPSS 13.0 software package.Outcome: when PACU retention time(Y) was greater than or equal 150 minutes, we make Y=1. When PACU retention time Y was less than 150 minutes, we make Y=0. Finally, 113 of the 495 cases with the ratio between male and female 2.36 were found to have Y=1. The total rate was 22.8%. Analysis of univariate and multivariate unconditional logistic regression showed the main risk factors were age(OR=0.000)、operation method(OR=0.094)、urine output (OR=0.000)、ASA grading (OR=0.004) and administration of cardiovascular-activity agents(OR=0.002).Conclusion: staff working on post-anesthesia recovery of thoracic patients should pay attention to the main risk factors, find and solve related problems in time. The risk factors deserve future research. ONE-LUNG VENTILATION VERSUS TWO-LUNG VENTILATION IN ANESTHESIA FOR NON-CARDIAC THORACIC SURGERIES:A SYSTEMATIC REVIEWObjective: To evaluate the safety of One-lung ventilation and two-lungventilation in anesthesia for non-cardiac thoracic surgeriesMethods: A computerized search of articles published between 1980 and September 2008 was performed using The Cochrane Library、MEDLINE、EMBASE and Chinese Biomedicine Database(CBM) to identify the clinical trials comparing One-lung ventilation and two-lung ventilation in anesthesia for non-cardiac thoracic surgeries. The quality of included studies was critically assessed and data analyses were performed with Cochrane Collaboration’s RevMan 5.0.Results: Five studies were included, involving 3 randomized trials、1 non- randomized trial and 1 retrospective trial. Meta-analyses showed that rates of blood-associated complications(including hypoxia and hypercapnia [OR=0.68,95%CI【0.31-1.51】P=0.46]、tube intubation-associated complications(including tube malposition, poor isolation, hoarseness, bronchial erosion )[OR=153,95%CI【0.25-9.58】P=0.65]、cardiovascular complications(including unstable hemodynamics, arrhythmia )[OR=1.00,95%C【I0.17-6.05】,P=1.00]、respiration system complications(including pneumonia,pulmonary edema,atelectasis, ARDS)[OR=0.68,95%CI【0.31-1.51】P=0.35] were similar between one-lung ventilation and two-lung ventilation groups.Conclusions: Based on these evidences, One-lung ventilation for non-cardiac thoracic surgeries is as safe as two-lung ventilation, but hematological complications and surgical complications were not demonstrated. Due to the poor quality of the included trials, more high-quality randomized trials are needed.更多还原