Occurrence And Causes Analysis Of COPD Patients With Pulmonary Complications After Abdominal Surgery

Objective: To analyze the incidence of Post-operation Pulmonary Complications(PPCs)and its related risk factors in patients with Chronic Obstructive Pulmonary Disease(COPD),and to investigate the effect of preoperative inhalation of anticholinergic drugs on PPCs in patients with COPD.Methods: Four hundred and twenty three patients with COPD with the history of abdominal surgery from the Second Affiliated Hospital of University of South China between 01-01-2015 and 12-31-2017 were collected and its incidence of PPCs was analyzed retrospectively.The clinical data was analyzed according to the operation time(< 2 hrs group and ? 2 hrs group),the severity of COPD(according to the international classification of COPD and airflow limitation,divided into A,B,C,D four groups),the anesthesia(General anesthesia group and Non-general anesthesia group),and its incidence was analyzed separately.The patients were divided into inhalation group and non-inhalation group according to the preoperative inhalation of anticholinergic drugs or not,and its effect for PPCs was analyzed.Chi-square test was used for comparison betweengroups,P < 0.05 was considered as statistically significant.Logistic regression multivariate analysis was used to analyze the independent risk factors,and P < 0.05 was considered as significant difference.Results: After abdominal surgery,84 of 423 patients with COPD occurred PPCs,and the incidence rate was 19.9%.The incidence of PPCs in the <2 hrs group(15.2%)was significant lower than that in the ?2hrs group(31.0%),(P =0.027 0).The incidence of PPCs in the group C and D(31.6%)was significant higher than that in group A and B(11.4%)(P = 0.017).The incidence of PPCs in general anesthesia patients(28.6%)was significant higher than that in non-general anesthesia patients(12.8%)(P < 0.05).The incidence of PPCs in patients with preoperative inhalation of anticholinergic drugs(12.7%)was significantly lower than that in patients without preoperative inhalation of anticholinergic drugs(29.0%)(P = 0.030).The results of the independent risk factor were analyzed between different groups.Operation time(?2 h)[odds ratio(OR)2.51,95% confidence interval(CI)(0.8-38.2),P = 0.019],severe COPD(group C and D)[3.43(1.1 59.3),P = 0.015],general anesthesia [2.72(1.9 16.1),P = 0.028],and non-preoperative inhalation of anticholinergic drugs[2.82(0.6 25.8),P = 0.032).Therefore,PPCs may be associated with the severity of chronic obstructive pulmonary disease and operative time.Conclusion: 1.Patients with COPD have a higher incidence of PPCs after abdominal surgery.2.The risk of PPCs for COPD patients ingroup C and D,general anesthesia during operation,and long operation time were significantly increased(P < 0.05).3.Preoperative inhalation of anticholinergic drugs can effectively reduce the risk of PPCs in patients with COPD(P < 0.05).