膈肌移动度与肺切除术后肺部并发症及近期预后的关系  

Relationship between diaphragmatic excursion and pulmonary complications and short-term prognosis after pneumonectomy

作　　者：岳红 王小文[2] 李林峻[2] 张勇[1] 陈丹[2] 吴庆琛[2] 贺雪梅[1] YUE Hong;WANG Xiaowen;LI Linjun;ZHANG Yong;CHEN Dan;WU Qingchen;HE Xuemei(Department of Ultrasound,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院超声科,重庆市400016 [2]重庆医科大学附属第一医院胸心外科,重庆市400016

出　　处：《临床超声医学杂志》2021年第4期276-279,共4页Journal of Clinical Ultrasound in Medicine

基　　金：医院学术带头人储备人才基金项目(xkts060)。

摘　　要：目的应用超声测量膈肌移动度,分析其与肺切除术后肺部并发症和近期预后的关系,探讨导致膈肌功能障碍的危险因素。方法选取我院胸外科行单侧肺切除术的患者90例,应用床旁超声分别于术前和术后24 h、48 h、72 h监测患者双侧膈肌移动度。根据术后膈肌移动度分为膈肌功能障碍组(DD组)54例和膈肌功能正常组(ND组)36例,比较两组术后肺部并发症发生情况及近期预后的差异,Logistic回归分析导致膈肌功能障碍的危险因素。结果DD组术后肺部并发症(肺复张不全、术后残腔、胸腔积液、肺部感染)发生率均高于ND组,差异均有统计学意义(均P<0.05);DD组近期预后(肺完全复张时间、术后带管时间)均较ND组差,差异均有统计学意义(均P<0.05)。两组患者术侧膈肌移动度均呈先下降后回升的趋势,健侧膈肌移动度术后48 h保持不变,从术后72 h开始代偿性增加。Logistic回归分析表明吸烟史、肺叶切除均为术后膈肌功能障碍的危险因素(OR=4.347、3.153,均P<0.05)。结论肺切除术后膈肌功能障碍导致肺部并发症发生率增高,不利于近期预后;床旁超声可用于测量围术期膈肌移动度,早期发现膈肌功能不全,为临床制定治疗方案提供依据。Objective To measure the diaphragmmtic excursion by ultrasound,and to analyze its relationship with postoperative pulmonary complications and short-term prognosis,to explore the risk factors leading to diaphragm dysfunction.Methods Ninety patients of unilateral pneumonectomy in thoracic surgery of our hospital were collected.Diaphragmatic excursion was measured sequentially for each patient before and 24 h,48 h,and 72 h after operation by bedside ultrasound.According to the postoperative diaphragmatic excursion,the patients were divided into diaphragm dysfunction group(DD group,n=54)and Normal diaphragmatic function group(ND group,n=36).The differences of the incidence of postoperative pulmonary complications and short-term prognosis between the two groups were compared.Logistic regression was used to analysis the risk factors leading to diaphragm dysfunction.Results The incidence of postoperative pulmonary complications(atelectasis,postoperative residual cavity,pleural effusion,and lung infection)in the DD group were higher than those in the ND group,and the differences were statistically significant(all P<0.05).The short-term prognosis of the DD group(the time to complete lung recruitment and post-operative catheterization)were worse than those of the ND group,the difference were statistically significant(both P<0.05).In both groups,diaphragmatic excursion first decreased and then increased on the operative side,while it remained unchanged on the opposite side at 48 h after operation and increased compensatively from 72 h after operation.Logistic regression analysis showed that smoking history and lobectomy were risk factors for postoperative diaphragmatic dysfunction(OR=4.347,3.153,both P<0.05).Conclusion Diaphragmatic dysfunction after pneumonectomy leads to higher incidence of pulmonary complications,which is not conducive to short-term prognosis.Bedside ultrasound can be used to measure the diaphragmatic excursion during peri-operative period,and early detection of diaphragm dysfunction,which can provide he

关 键 词：超声检查 膈肌移动度 肺切除术 预后 

分 类 号：R445.1[医药卫生—影像医学与核医学]