高体质量指数对胸腔镜下肺癌根治术围术期并发症及临床疗效的影响  

Effect of high body mass index on perioperative complications under thoracoscope radical resection of lung cancer and its clinical efficacy

作　　者：王朋飞[1] 代伟娜 刘礼新 马敏杰[2] 韩彪[2] Wang Pengfei;Dai Weina;Liu Lixin;Ma Minjie;Han Biao(the First School of Clinical Medicine of Lanzhou University, Lanzhou 730030, China;Department of Thoracic Surgery, the First Hospital of Lanzhou University, Lanzhou 730030, China)

机构地区：[1]兰州大学第一临床医学院,730030 [2]兰州大学第一医院胸外科,730030

出　　处：《肿瘤研究与临床》2019年第3期167-171,共5页Cancer Research and Clinic

摘　　要：目的探讨高体质量指数(BMI)对胸腔镜下肺癌根治术围术期并发症及临床疗效的影响。方法回顾性分析兰州大学第一医院胸外科2012年1月至2017年12月收治的胸腔镜下肺癌根治术患者235例,根据中国BMI标准,分为正常BMI(BMI≥18.5kg/m^2且<24.0kg/m^2)组147例和高BMI(BMI≥24.0kg/m^2)组88例。采用χ^2检验和t检验比较两组患者术后并发症的发生率和临床疗效,logistic回归分析高BMI是否为肺癌患者术后院内肺部感染独立危险因素。结果高BMI组比正常BMI组的肺部感染[17.0%(15/88)比6.1%(9/147),χ^2=7.162,P<0.05]、肺不张[11.4%(10/88)比3.4%(5/147),χ^2=5.840,P<0.05]、呼吸衰竭[5.7%(5/88)比0.1%(1/147),χ^2=5.535,P<0.05]以及切口愈合不良[10.2%(9/88)比3.4%(5/147),χ^2=4.578,P<0.05]发生率高;高BMI组比正常BMI组术后恢复时间[(7.1±1.4)d比(6.7±0.8)d,t=2.706,P<0.05]及胸部引流管拔除时间[(3.8±1.6)d比(3.4±0.7)d,t=3.089,P<0.05]长。多因素分析结果表明,糖尿病、高血压、高BMI、手术时间长、年龄大、吸烟史是肺癌根治术患者术后发生院内肺部感染的独立危险因素(均P<0.05)。结论高BMI患者胸腔镜下肺癌根治术后肺部感染、肺不张、切口愈合不良的发生率高,术后恢复时间、拔管时间相对延长。高BMI是肺癌患者术后院内肺部感染的独立危险因素。Objective To investigate the effect of high body mass index (BMI) on perioperative complications under thoracoscope radical resection of lung cancer and its clinical efficacy. Methods A total of 235 patients who received pulmonary radical resection under thoracoscope between January 2012 and December 2017 in Department of Thoracic Surgery of the First Hospital of Lanzhou University were retrospectively analyzed. The patients were divided into normal BMI group (BMI≥18.5 kg/m^2 and BMI < 24.0 kg/m^2, n = 147) and high BMI group (BMI≥24.0 kg/m^2, n = 88) according to BMI in China. The incidence of postoperative complications and clinical efficacy were compared by using χ^2 test and t test. Logistic regression was used to identify that if high BMI was the independent risk factor of postoperative pulmonary infection in patients with lung cancer. Results The incidence of the complications in high BMI group was higher than that in normal BMI group, including pulmonary infection [17.0%(15/88) vs. 6.1%(9/147),χ^2 = 7.162, P < 0.05], pulmonary atelectasis [11.4%(10/88) vs. 3.4%(5/147),χ^2 = 5.840, P < 0.05], respiratory failure [5.7%(5/88) vs. 0.1%(1/147),χ^2 = 5.535, P < 0.05] and poor wound healing [10.2%(9/88) vs. 3.4%(5/147),χ^2 = 4.578, P < 0.05]. Postoperative recovery time [(7.1±1.4) d vs.(6.7±0.8) d, t = 2.706, P < 0.05], chest drainage tube removal time [(3.8±1.6) d vs.(3.4±0.7) d, t = 3.089, P < 0.05] in high BMI group were longer than those in normal BMI group. Multiple-factor analysis showed that the independent risk factors were diabetes, high blood pressure, high BMI, long operation time, old age, smoking history (all P < 0.05). Conclusions The incidence of pulmonary infection, pulmonary atelectasis and poor wound healing for the patients with high BMI is increased. Besides, postoperative recovery time and chest drainage tube removal time are prolonged. High BMI is an independent risk factor of pulmonary infection.

关 键 词：人体质量指数 肺肿瘤 肺叶切除术 围手术期并发症 

分 类 号：R734.2[医药卫生—肿瘤]