胸腔镜肺叶切除术老年患者术前衰弱与术后肺部并发症的关系  

Relationship between preoperative frailty and postoperative pulmonary complications in elderly patients undergoing thoracoscopic lobectomy

作　　者：陈丹丹 方婷婷 丁怡 祝文澜[1] 袁凤来 王志强[4] 董楠[1] 张继如[1] Chen Dandan;Fang Tingting;Ding Yi;Zhu Wenlan;Yuan Fenglai;Wang Zhiqiang;Dong Nan;Zhang Jiru(Department of Anesthesiology,Affiliated Hospital of Jiangnan University,Wuxi 214125,China;Intensive Care Unit,Affiliated Hospital of Jiangnan University,Wuxi 214125,China;Institute of Integrated Chinese and Western Medicine,Affiliated Hospital of Jiangnan University,Wuxi 214125,China;Department of Thoracic Surgery,Affiliated Hospital of Jiangnan University,Wuxi 214125,China)

机构地区：[1]江南大学附属医院麻醉科,无锡214125 [2]江南大学附属医院重症医学科,无锡214125 [3]江南大学附属医院中西医研究所,无锡214125 [4]江南大学附属医院胸外科,无锡214125

出　　处：《中华麻醉学杂志》2021年第8期928-932,共5页Chinese Journal of Anesthesiology

基　　金：江苏省科学技术厅社会发展面上项目(BE2020634);无锡市医疗卫生中青年拔尖人才(BJ2020049);江苏省科学技术厅自然科学基金面上项目(BK20191138)。

摘　　要：目的评价胸腔镜肺叶切除术老年患者术前虚弱与术后肺部并发症(PPCs)的关系。方法收集江南大学附属医院择期行胸腔镜肺叶切除术非小细胞肺癌老年患者,记录一般资料、衰弱状态、血液指标和手术相关指标等,根据住院期间是否发生PPCs将患者分为PPCs组和未发生PPCs组,比较各指标间的差异,采用logistic回归分析PPCs的独立危险因素,使用分层分析和交互作用检验进一步分析衰弱与PPCs的关系。结果共纳入行胸腔镜下肺叶切除术非小细胞肺癌老年患者298例,PPCs发生率为22.8%。与未发生PPCs组相比,PPCs组患者白蛋白和FEV1/FVC降低,年龄、血肌酐、糖尿病比率、COPD比率和术前衰弱率升高(P<0.05)。logistic回归分析结果显示,COPD和术前衰弱是PPCs的独立危险因素。在调整所有风险变量后,衰弱与非衰弱患者相比,PPCs发生风险增加了171%(OR值=2.71,95%CI:1.18~4.73,P<0.05)。亚组分析结果表明,BMI和手术时间对衰弱与PPCs之间的关联存在效应修饰作用(交互作用P<0.05)。结论COPD和术前衰弱是胸腔镜肺叶切除术老年患者PPCs的独立危险因素,术前衰弱伴有肥胖或手术时间较长的老年患者发生PPCs的风险更高。Objective To evaluate the relationship between preoperative frailty and postoperative pulmonary complications(PPCs)in elderly patients undergoing thoracoscopic lobectomy.Methods The elderly patients with non-small cell lung cancer who underwent thoracoscopic lobectomy in the Affiliated Hospital of Jiangnan University were collected.The general data,frailty status,parameters of blood and operation-related parameters were recorded.The patients were divided into PPC group and non-PPC group according to whether PPCs occurred during hospitalization,and the differences between the parameters were compared.Logistic regression analysis was used to analyze the independent risk factors for PPCs.Stratification analysis and interaction test were used to further analyze the relationship between frailty and PPCs.Results A total of 298 elderly patients with non-small cell lung cancer undergoing thoracoscopic lobectomy were included in this study,and the incidence of PPCs was 22.8%.Compared with non-PPC group,the albumin and FEV1/FVC were decreased,and age,blood creatinine,ratio of diabetes mellitus,ratio of chronic obstructive pulmonary disease(COPD)and rate of preoperative frailty were significantly increased in PPC group(P<0.05).The results of logistic regression analysis showed that COPD and preoperative frailty were independent risk factors for PPCs.After adjusting all the risk variables,the frail patients had a 171%increased risk of PPCs compared with non-frail patients(OR value=2.71,95%CI:1.18-4.73,P<0.05).The results of subgroup analysis showed that body mass index and operation time had effect modification on the association between frailty and PPCs(interaction P<0.05).Conclusion COPD and preoperative frailty are independent risk factors for PPCs in elderly patients undergoing thoracoscopic lobectomy,and the frail patients with obesity or long operation time are at higher risk of PPCs.

关 键 词：手术后并发症 肺叶切除术 胸腔镜检查 老年人 衰弱 

分 类 号：R734.2[医药卫生—肿瘤]