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NTIS 바로가기기본간호학회지 = Journal of Korean Academy of Fundamentals of Nursing, v.26 no.1, 2019년, pp.32 - 41
주순여 (가톨릭대학교 서울성모병원 외과중환자실) , 김희승 (가톨릭대학교 간호대학)
Purpose: The purpose of this study was to identify the risk factors for postoperative pulmonary complications (PPCs) after upper or lower abdominal digestive tract surgery. Methods: Participants in this retrospective observational study had undergone upper or lower digestive tract surgery and entere...
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핵심어 | 질문 | 논문에서 추출한 답변 |
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수술 후 폐 합병증의 정의는 무엇인가? | 수술 후 폐 합병증(PPCs)은 여러 연구에 의해 다양하게 정의되나 일반적으로 수술 후 폐 합병증은 개별적으로 폐렴, 급성호흡곤란 증후군(Acute Respiratory Distress Syndrome, ARDS), 급성 호흡부전(Acute Respiratory Failure, ARF)으로 정의하거나 무기폐, 기관지 연축, 기관지염, COPD 악화, 폐기종을 포함하여 복합적으로 정의하기도 한다[7]. 유럽에서는 수술 임상결과 지침(European Perioperative Clinical Outcome, EPCO)에서 수술 후 폐 합병증을 호흡기 감염, 호흡부전, 흉막 삼출, 무기폐, 기흉, 기관지 연축, 폐렴, 급성 호흡곤란증후군(ARDS)을 포함하여 정의하였고[7], 미국내과학회(American College of Physicians, ACP)에서는 폐렴, 호흡부전으로 정의하였다[5]. | |
수술 후 폐 합병증은 어떻게 발생하는가? | 수술 후 폐 합병증(PPCs)은 수술 중 인공환기와 마취 약물로 인한 호흡중추의 억압, 호흡근육의 약화, 흉벽기능의 장애로 폐 용적의 변화와 기능적 잔기량의 감소를 발생시키며[7], 복부수술로 복막 내장 신경자극으로 횡격막 수용체의 신경전달을 억제하는 중추신경계가 반사적으로 활성화되어 호흡근육에 기능장애가 발생하여 폐 합병증이 발생하게 된다[10]. 또한 수술 후 마취제 잔여효과와 마약성 진통제의 지속적인 진정효과로 호흡중추의 억압이 유지되며, 수술 후 통증으로 폐 용적이 감소하며 비효율적인 기침으로 객담이 정체된다[7,10]. | |
수술 후 폐 합병증의 예측요인으로는 무엇이 있는가? | 수술 후 폐 합병증의 예측요인은 수술 전 환자요인, 수술 요인, 검사 관련 요인으로 구분할 수 있다[4,7]. 수술 전 환자 요인으로는 나이, 몸무게 변화, 활동성 정도, 흡연, 기저질환, 체질량 지수 등이 있으며, 수술 관련 요인으로는 미국마취과 학회의 환자 신체상태 분류(ASA level), 수술 종류, 마취 종류 및 시간, 수술 중 수혈 정도, 응급수술 등이 있고, 검사 관련 요인으로는 수술 전 혈중 헤모글로빈 농도(Hb), 혈중 혈액요소질소 농도(BUN), 혈중 알부민 농도(alb), 폐기능 검사 결과 등이 있다[5,7-9]. |
Weiser TG, Haynes AB, Molina G, Lipsitz SR, Esquivel MM, Uribe-Leitz T, et al. Size and distribution of the global volume of surgery in 2012. Bulletin of the World Health Organization. 2016;94(3):201-209f. https://doi.org/10.2471/blt.15.159293
National Health Insurance Service. The Main Surgery Statistical Yearbook for 2015 [Internet]. Gangwon: National Health Insurance Service; 2015 [cited 2018 Oct 1]. Available from: http://www.nhis.or.kr/bbs7/boards/B0079/22272?boardKey33&sortsequence&orderdesc&rows10&messageCategoryKey&pageNumber1&viewTypegeneric&targetType12&targetKey33&status&period&startdt&enddt&queryField&query
Lawson EH, Hall BL, Louie R, Ettner SL, Zingmond DS, Han L, et al. Association between occurrence of a postoperative complication and readmission: Implications for quality improvement and cost savings. Annals of Surgery. 2013;258(1):10-18. https://doi.org/10.1097/SLA.0b013e31828e3ac3
Thanavaro JL, Foner BJ. Postoperative pulmonary complications. Nursing Critical Care. 2016;11(1):38-47. https://doi.org/10.1097/01.CCN.0000475517.50129.0a
Canet J, Gallart L, Gomar C, Paluzie G, Valle?s J, Castillo J, et al. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology. 2010;113(6):1338-1350. https://doi.org/10.1097/ALN.0b013e3181fc6e0a
Yang CK, Teng A, Lee DY, Rose K. Pulmonary complications after major abdominal surgery: National Surgical Quality Improvement Program analysis. Journal of Surgical Research. 2015;198(2):441-449. https://doi.org/10.1016/j.jss.2015.03.028
Miskovic A, Lumb AB. Postoperative pulmonary complications. British Journal of Anaesthesia. 2017;118(3):317-334. https://doi.org/10.1093/bja/aex002
Fernandez-Bustamante A, Frendl G, Sprung J, Kor DJ, Subramaniam B, Martinez Ruiz R, et al. Postoperative pulmonary complications, early mortality, and hospital stay following noncardiothoracic surgery: A multicenter study by the perioperative research network investigators. JAMA Surgery. 2017;152(2):157-166. https://doi.org/10.1001/jamasurg.2016.4065
Jeong BH, Shin B, Eom JS, Yoo H, Song W, Han S, et al. Development of a prediction rule for estimating postoperative pulmonary complications. PloS One. 2014;9(12):e113656. https://doi.org/10.1371/journal.pone.0113656
Beaussier M, Genty T, Lescot T, Aissou M. Influence of pain on postoperative ventilatory disturbances. Management and expected benefits. Annales Francaises d'Anesthcsie et de Reanimation. 2014;33(7-8):484-486. https://doi.org/10.1016/j.annfar.2014.07.005
Canet J, Sabate? S, Mazo V, Gallart L, de Abreu MG, Belda J, et al. Development and validation of a score to predict postoperative respiratory failure in a multicentre European cohort: A prospective, observational study. European Journal of Anaesthesiology. 2015;32(7):458-470. https://doi.org/10.1097/EJA.0000000000000223.
Doh YJ, Hur IK, Lee JY, Park JB, Sung NI, Lee YG, et al. Reappraisal of the predictive factors for postoperative pulmonary complications after general anesthesia. Korean Journal of Medicine. 2007;72(5):501-510.
Hokari S, Ohshima Y, Nakayama H, Suzuki R, Kajiwara T, Koya T, et al. Superiority of respiratory failure risk index in prediction of postoperative pulmonary complications after digestive surgery in Japanese patients. Respiratory Investigation. 2015;53(3):104-110. https://doi.org/https://doi.org/10.1016/j.resinv.2014.12.004
Hedenstierna G, Edmark L. Mechanisms of atelectasis in the perioperative period. Best Practice & Research: Clinical Anaesthesiology. 2010;24(2):157-169. https://doi.org/10.1016/j.bpa.2009.12.002.
Choi PJ, Jeong SS. Clinical Analysis of Risk Factors in Pulmonary Complications after Curative Resection of Esophageal Cancer. Korean Journal of Bronchoesophagology. 2011;17(2):98-103.
Souza Possa S, Braga Amador C, Meira Costa A, Takahama Sakamoto E, Seiko Kondo C, Maida Vasconcellos AL, et al. Implementation of a guideline for physical therapy in the postoperative period of upper abdominal surgery reduces the incidence of atelectasis and length of hospital stay. Revista Portuguesa de Pneumologia. 2014;20(2):69-77. https://doi.org/10.1016/j.rppneu.2013.07.005.
Canet J, Gallart L. Postoperative respiratory failure: Pathogenesis, prediction, and prevention. Current Opinion in Critical Care. 2014;20(1):56-62. https://doi.org/10.1097/MCC.0000000000000045
Gupta H, Gupta PK, Schuller D, Fang X, Miller WJ, Modrykamien A, et al. Development and validation of a risk calculator for predicting postoperative pneumonia. Mayo Clinic Proceedings. 2013;88(11):1241-1249. https://doi.org/10.1016/j.mayocp.2013.06.027
Chughtai M, Gwam CU, Mohamed N, Khlopas A, Newman JM, Khan R, et al. The epidemiology and risk factors for postoperative pneumonia. Journal of Clinical Medicine Research. 2017;9(6):466-475. https://doi.org/10.14740/jocmr3002w
Inokuchi M, Kojima K, Kato K, Sugita H, Sugihara K. Risk factors for post-operative pulmonary complications after gastrectomy for gastric cancer. Surgical Infections. 2014;15(3):314-321. https://doi.org/10.1089/sur.2013.031
Ohkura Y, Shinohara H, Shindoh J, Haruta S, Ueno M, Sakai Y, et al. A new scoring system using preoperative factors and contour mapping for predicting postoperative complications of laparoscopic gastrectomy. Digestive Surgery. 2016;33(1):74-81. https://doi.org/10.1159/000442028.
Nguyen NT, Wolfe BM. The physiologic effects of pneumoperitoneum in the morbidly obese. Annals of Surgery. 2005; 241(2):219-226. https://doi.org/10.1097/01.sla.0000151791.93571.70
Kim YB, Chang CH, Kim SY, Nam YT. Effect of BMI and Patient Positioning on Airway Pressures and Respiratory Compliance during Laparoscopic Surgery. Korean Journal of Anesthesiology. 2006;50(3):302-307. https://doi.org/10.4097/kjae.2006.50.3.302
Johnson RG, Arozullah AM, Neumayer L, Henderson WG, Hosokawa P, Khuri SF. Multivariable predictors of postoperative respiratory failure after general and vascular surgery: Results from the patient safety in surgery study. Journal of the American College of Surgeons. 2007;204(6):1188-1198. https://doi.org/10.1016/j.jamcollsurg.2007.02.070.
O'Neill F, Carter E, Pink N, Smith I. Routine preoperative tests for elective surgery: summary of updated NICE guidance. BMJ. 2016;354:i3292. https://doi.org/10.1136/bmj.i3292
Committee on Standards and Practice Parameters, Apfelbaum JL, Connis RT, Nickinovich DG, American Society of Anesthesiologists Task Force on Preanesthesia Evaluation, Pasternak LR, et al. Practice advisory for preanesthesia evaluation: an updated report by the American Society of Anesthesiologists Task Force on Preanesthesia Evaluation. Anesthesiology. 2012;116(3):522-538. https://doi.org/10.1097/ALN.0b013e31823c1067
Lee CZ, Kao LT, Lin HC, Wei PL. Comparison of clinical outcome between laparoscopic and open right hemicolectomy: A nationwide study. World Journal of Surgical Oncology. 2015;13:250. https://doi.org/10.1186/s12957-015-0666-7
Blum JM, Stentz MJ, Dechert R, Jewell E, Engoren M, Rosenberg AL, et al. Preoperative and intraoperative predictors of postoperative acute respiratory distress syndrome in a general surgical population. Anesthesiology. 2013;118(1):19-29. https://doi.org/10.1097/ALN.0b013e3182794975
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