电视胸腔镜治疗创伤性血胸后并发症发生的危险因素分析  

Risk factors associated with postoperative complications of video-assisted thoracic surgery for traumatic hemothorax

作　　者：辛少伟 王涛 辛向兵 韩勇 Xin Shaowei;Wang Tao;Xin Xiangbing;Han Yong(Department of Thoracic Surgery,Tangdu Hospital,Air Force Medical University,Xi'an 710038,China;Department of Thoracic Surgery,962nd Hospital of Joint Logistics Support Force,Harbin 150000,China)

机构地区：[1]空军军医大学唐都医院胸外科,西安710038 [2]解放军联勤保障部队第962医院胸外科,哈尔滨150000

出　　处：《中华创伤杂志》2020年第7期619-623,共5页Chinese Journal of Trauma

基　　金：空军军医大学科技发展基金(2018XA010)。

摘　　要：目的探讨电视胸腔镜手术(VATS)治疗创伤性血胸后并发症发生的相关危险因素。方法采用回顾性病例对照研究分析2012年1月1日—2018年12月31日空军军医大学唐都医院收治的94例行VATS治疗的创伤性血胸患者临床资料,其中男75例,女19例;年龄15~78岁[(45.8±14.6)岁]。其中12例术后出现并发症(并发症组),82例术后未出现并发症(无并发症组)。收集患者的性别、年龄、致伤原因、气胸及血胸情况、肋骨骨折数目、简明损伤定级(AIS)、损伤严重度评分(ISS)、受伤至手术时间、手术时间、肋骨固定与否、发现肺漏气与否、引流时间、术后胸腔引流量及术后住院时间等资料。通过单因素及Logistic回归分析与并发症发生相关的危险因素。结果并发症组受伤至手术时间>3 d的比例、引流时间及术后住院时间[75%(9/12)、(7.8±2.6)d、(10.2±2.7)d]均显著高于或长于无并发症组[分别为37%(30/82)、(5.5±1.6)d、(8.0±2.3)d](P<0.05或0.01)。而两组性别、年龄、致伤原因、气胸及血胸情况、肋骨骨折(≥3根)与否、AIS、ISS、手术时间、肋骨固定与否、发现肺漏气与否及术后引流量差异均无统计学意义(P>0.05)。多因素Logistic回归分析表明,受伤至手术时间>3 d及术中发现肺漏气与VATS治疗创伤性血胸后并发症发生显著相关(P<0.05)。结论受伤至手术时间>3 d及术中发现肺漏气是VATS治疗创伤性血胸后并发症发生的独立危险因素。Objective To investigate the risk factors associated with the complications of video-assisted thoracic surgery(VATS)in the treatment of traumatic hemothorax.Methods A retrospective case-control study was conducted to analyze the clinical data of 94 patients with traumatic hemothorax undergone VATS treatment in Tangdu Hospital of Air Force Medical University from January 1,2012 to December 31,2018.There were 75 males and 19 females,aged from 15-78 years[(45.8±14.6)years].Postoperative complications occurred in 12 patients(complication group)and not in 82 patients(non-complication group).The following data were analyzed for complication-related risk factors using univariate analysis and Logistic regression analysis,including gender,age,mechanism of injury,pneumothorax and hemothorax,number of fractured ribs,abbreviated injury score(AIS),injury severity score(ISS),time from injury to operation,operation time,rib fixation or not,pulmonary air leakage or not,duration of drainage,postoperative volume of drainage,and postoperative length of hospital stay.Results The proportion of patients with time from injury to operation(>3 days),duration of drainage and postoperative length of hospital stay in complication group[75%(9/12),(7.8±2.6)days,(10.2±2.7)days]were significantly higher or longer than those in non-complication group[37%(30/82),(5.5±1.6)days,(8.0±2.3)days](P<0.05 or 0.01).There were no statistically significant differences between the two groups in gender,age,mechanism of injury,pneumothorax and hemothorax conditions,number of fractured ribs(≥3),AIS,ISS,operation time,rib fixation or not,pulmonary air leakage or not and postoperative volume of drainage(P>0.05).Logistic regression analysis showed time from injury to operation(>3 days)and pulmonary air leakage were significantly associated with the complications of VATS(P<0.05).Conclusion Time from injury to operation(>3 days)and pulmonary air leakage are independent risk factors for the complications of VATS in the treatment of traumatic hemothorax.

关 键 词：血胸 胸腔镜检查 危险因素 

分 类 号：R655[医药卫生—外科学]