COPDの68歳の男性が,大腸がんの手術を検討している
1Beth Israel Deaconess Medical Center, Shapiro 621D, 330 Brookline Ave, Boston, MA 02215, USA. gsmetana@bidmc.harvard.edu
JAMA
|May 18, 2007
まとめ
大腸がんや慢性閉塞性肺疾患 (COPD) の高齢患者は,手術のリスクが高くなります. 術前評価と標的型戦略は,腹部外科手術後の肺合併症を軽減することができます.
科学分野:
- 肺内医学 肺内医学 肺内医学
- 外科腫瘍学外科腫瘍学
- アネステシオロジー アネステシオロジー
背景:
- 大腸がんは,治癒のための治療のために外科的介入を必要とします.
- 慢性阻害性肺疾患 (COPD) は,手術後の肺リスクを大幅に増加させます.
- COPDのような併発性疾患を有する患者の手術リスクの評価は極めて重要です.
研究 の 目的:
- 手術後の肺合併症の患者および処置関連の危険因子をレビューする.
- 手術リスクの評価における術前検査の役割について議論する.
- Mr.A.のような患者の肺合併症を減らすための根拠に基づいた戦略を提示する.
主な方法:
- 術後の肺合併症のリスク要因に関する文献のレビュー.
- 肺機能に対する術前評価ツールの分析.
- 肺疾患のリスクを軽減するための介入を支持する証拠の検討.
主要な成果:
- 患者に関係する要因 (例えば,COPDの重症度,喫煙歴) は,肺リスクに大きな影響を及ぼします.
- 処置に関連する要因 (例えば,手術の種類と期間) もリスクに寄与します.
- 術前最適化と特定の手術内/手術後の戦略は,合併症の発生率を減らすことができます.
結論:
- 大手手術を受けるCOPD患者の場合,肺の合併症のリスクが高くなります.
- 総合的な手術前評価とリスク軽減戦略は,結果を最適化するために不可欠です.
- 調整された管理計画により,呼吸器の離乳成功を向上させ,罹病率を低下させることができます.
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