日间胸腔镜手术患者术后肺部并发症危险因素分析  

Risk factors of postoperative pulmonary complications in patients undergoing thoracic surgery in Day Care Unit

作　　者：路子蕴 孙行 徐璐[1] 杨如松 王涛[2] 史敏科[2] 马正良[1] 孙玉娥[1] 李冰冰[1] LU Ziyun;SUN Hang;XU Lu;YANG Rusong;WANG Tao;SHI Minke;MA Zhengliang;SUN Yu′e;LI Bingbing(不详;Department of Anesthesia Surgery,Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院麻醉手术科,南京210008 [2]南京大学医学院附属鼓楼医院心胸外科,南京210008

出　　处：《实用医学杂志》2023年第24期3205-3209,共5页The Journal of Practical Medicine

基　　金：江苏省第六期“333高层次人才培养工程”[编号:(2022)3-1-244]。

摘　　要：目的探讨日间胸腔镜手术患者在出院后1个月内肺部并发症(PPCs)的发生率及其危险因素。方法选取2022年6-10月南京鼓楼医院集中式管理日间病房拟行择期电视辅助胸腔镜手术(VATS)患者200例,所有患者围术期实施加速康复外科(ERAS)管理。患者术后第1天晨由1名研究者在床旁行肺超声(LUS)检查。患者在出院后1月内至少在门诊完成1次X线或CT检查。根据影像学随访结果及患者复诊时临床症状主诉,明确是否发生PPCs,并将患者分为肺部并发症组(PPC+组)和正常组(PPC-组)。采用单因素分析VATS术后发生PPCs的相关影响因素,多因素logistic回归分析筛选独立危险因素。结果共有188例VATS患者接受了LUS检查并完成了1个月的随访,其中68例(36.1%)发生了不同种类的PPCs。多因素logistic回归分析显示,术前合并免疫系统疾病(OR=24.36,95%CI:1.63~371.45,P=0.021)、行肺叶切除术(OR=1.01,95%CI:0.98~1.02,P=0.031)和术后第1天LUSS高(OR=1.37,95%CI:1.12~1.68,P=0.002)是行日间VATS手术患者出院后1个月内发生PPCs的独立危险因素。结论合并免疫系统疾病、行肺叶切除术及术后第1天LUSS升高是日间VATS手术患者出院后1月内发生PPCs的独立危险因素。Objective To determine risk factors of postoperative pulmonary complications within 1 month in patients undergoing thoracic surgery in Day Care Unit.Methods The total of 200 patients routinely scheduled for VATS under centralized management were enrolled in this study.On the postoperative day 1,lung ultrasound(LUS)was conducted by one physician in the ward.The patients received at least once Chest X-ray or CT in outpatient department within 30 days after discharge.The composite of out-of-hospital PPCs,and the value of LUSS in predicting the PPCs was appraised.Furthermore,we identified the perioperative risk factors associated with PPCs in VATS patients.Results Of 200 recruited VATS patients eligible in the Nanjing Drum Tower Hospital,188 participants received LUS examination and finally completed the 30 days follow-up.Of whom,68 patients developed the varied types of PPCs.Multivariable Logistic regression analysis indicated that comorbidity of immune system disease(P=0.021),lobar resection(P=0.031)and the postoperative 24 hours LUSS(P=0.002)were independent risk factors for PPCs within 30 days after VATS.Conclusion Comorbidity of immune system disease,lobar resection and the postoperative 24 h LUSS were independent risk factors for PPCs within 30 days after VATS。

关 键 词：日间手术 电视胸腔镜辅助手术 术后肺部并发症 加速康复外科 

分 类 号：R614[医药卫生—麻醉学]