婴儿单肺通气胸腔镜手术后肺部并发症的发生率及其危险因素分析  

Incidence and Risk Factors of Post-operative Pulmonary Complications in Infants Undergoing Thoracoscopic Surgery Under One-lung Ventilation

作　　者：潘守东 陈刚[2] 李帆[2] 刘菁[3] 张晓伦[3] 张昱[1,4] 晏馥霞[1,4] PAN Shou-dong;CHEN Gang;LI Fan;LIU Jing;ZHANG Xiao-lun;ZHANG Yu;YAN Fuxiau(Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100370;Department of Anesthesiology,Children’s Hospital,Capital Institute of Pediatrics,Beijing,100020;Department of Thoracic and Oncology Surgery,Children’s Hospital,Capital Institute of Pediatrics,Beijing,1000203;Anesthesiology Center,Fuwai Hospital,Chinese Academy of Medical Sciences,Beijing 100037,China)

机构地区：[1]北京协和医学院中国医学科学院,北京市100730 [2]首都儿科研究所附属儿童医院麻醉科,北京市100020 [3]首都儿科研究所附属儿童医院胸部及肿瘤外科,北京市100020 [4]中国医学科学院阜外医院麻醉中心,北京市100037

出　　处：《中国分子心脏病学杂志》2021年第2期3809-3812,共4页Molecular Cardiology of China

基　　金：首都临床特色应用研究基金(Z181100001718096)。

摘　　要：目的探讨婴儿单肺通气下胸腔镜手术术后肺部并发症(postoperative pulmonary complication,PPC)的发生率及其危险因素。方法回顾性分析2016年1月至2020年12月择期在单肺通气下行胸腔镜手术的婴儿295例,年龄1~12月龄。根据患儿是否发生PPC分为2组:对照组患儿未发生PPC(n=241);病例组患儿发生PPC(n=54)。计算患儿PPC的发生率,通过多因素Logistic回归分析PPC的独立危险因素,比较两组患儿的术后转归和医疗费用。结果本组PPC的发生率为18.3%。多因素Logistic回归分析显示,PPC的3项独立危险因素为纵隔肿物手术(OR=7.4,95%CI:2.4-22.5)、术中呼气末二氧化碳分压(PetCO2)>50 mmHg(OR=3.4,95%CI:1.2-9.6)和术毕氧合指数(OI)<290 mmHg(OR=4.6,95%CI:1.6-12.9)。与对照组相比,病例组术后转入ICU百分比(33.3%vs 1.2%,P<0.05)、术后住院时间[8(6-12)d vs 6(5-7)d,(P<0.05)]和住院费用[4.3(3.6-6.4)万元vs 3.6(3.3-3.9)万元,(P<0.05)]均显著增加。所有患儿均痊愈出院。结论婴儿单肺通气下胸腔镜手术PPC的发生率高,纵隔肿物手术、术中PetCO2高于50 mmHg和术毕OI低于290 mmHg是其独立危险因素。发生PPC的患儿进入ICU百分比、术后住院时间和医疗费用均显著增加。Objective To investigate the incidence and risk factors of post-operative pulmonary complications(PPC)in infants undergoing thoracoscopic surgery with one-lung ventilation.Methods From January 2016 to December 2020,295 infants aged from 1 to 12 months old receiving elective thoracoscopic surgery with one lung ventilation in our hospital were enrolled in this retrospective study.They were divided into two groups:control group(n=241)and case group(n=54),according to the PPC occurrence.The incidence of PPC was calculated.The independent risk factors of PPC were analyzed by multivariate Logistic regression.The postoperative outcomes and medical costs were compared between the two groups.Results The incidence of PPC was 18.3%in this study.Multivariate Logistic regression analysis showed that mediastinal mass surgery(OR=7.4,95%CI:2.4-22.5),intra-operative maximum PetCO2>50 mmHg(OR=3.4,95%CI:1.2-9.6)and postoperative oxygen index(OI)<290 mmHg(OR=4.6,95%CI:1.6-12.9)were independent risk factors of PPC.The patients in the case group had significantly increased percentage of postoperative ICU admission(33.3%vs 1.2%,P<0.05),post-operative length of stay in hospital[8(6-12)days vs 6(5-7)days,P<0.05],and medical costs[43000(36000-64000)RMB vs 36000(33000-39000)RMB,(P<0.05)]compared with the control group.All the patients recovered and discharged uneventfully.Conclusion The incidence of PPC is high in infants undergoing thoracoscopic surgery with single lung ventilation.Mediastinal mass surgery,intra-operative PetCO2 over 50 mmHg,and post-operative oxygenation index less than 290 mmHg are independent risk factors of PPC.The percentage of ICU admission,post-operative length of stay in hospital and medical costs significantly increased in infants with PPC.

关 键 词：婴儿 胸腔镜手术 单肺通气 术后肺部并发症 危险因素 

分 类 号：R726.5[医药卫生—儿科]