日间胸腔镜手术患者围术期安全性及延迟出院危险因素分析  

Safety analysis of video-assisted thoracic surgery in Day Care Unit and the risk factors for delayed discharge

作　　者：徐璐[1] 路子蕴 邱莉华 许华晔 王涛[2] 史敏科[2] 马正良[1] 李冰冰[1] XU Lu;LU Ziyun;QIU Lihua;XU Huaye;WANG Tao;SHI Minke;MA Zhengliang;LI Bingbing(Anesthesia Surgery Department,Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School,Nanjing,210009,P.R.China;General Thoracic Surgery Department,Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School,Nanjing,210009,P.R.China)

机构地区：[1]南京大学医学院附属鼓楼医院麻醉手术科,南京210009 [2]南京大学医学院附属鼓楼医院普胸外科,南京210009

出　　处：《中国胸心血管外科临床杂志》2024年第4期551-555,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的探索集中管理模式下日间病房收治的胸腔镜手术(video-assisted thoracic surgery,VATS)患者围术期安全性,并分析延迟出院的危险因素。方法回顾性纳入南京鼓楼医院日间病房在2021年收治的VATS患者,分析患者围术期资料及延迟出院的危险因素。结果共纳入383例患者,其中男179例、女204例,年龄(46.09±14.82)岁。11例(2.87%)患者住院期间发生3~4级术后并发症,18例(4.70%)患者出院7 d内非计划门急诊就诊,6例(1.57%)患者出院30 d内再住院,其余患者出院30 d随访中均无明显不适。平均住院时间(2.27±0.35)d,48例(12.53%)患者延期出院。患者进行肺叶切除或肺联合切除手术[OR=3.015,95%CI(1.174,7.745),P=0.022]是延迟出院的独立危险因素。结论集中式日间手术管理模式下进行VATS安全有效,延迟出院与手术切除范围相关。Objective To explore the perioperative safety of video-assisted thoracic surgery(VATS)in Day Care Unit and the risk factors for delayed discharge under centralized management model.Methods The patients with VATS managed by the Day Care Unit of the Drum Tower Hospital Affiliated to Nanjing University Medical School in 2021 were retrospectively collected.The patients’postoperative data and risk factors for delayed discharge were analyzed.Results A total of 383 patients were enrolled,including 179 males and 204 females with an average age of 46.09±14.82 years.Eleven(2.87%)patients developed grade 3-4 postoperative complications during the hospitalization.Eighteen(4.70%)patients visited unscheduled outpatient clinic within 7 days,and 6(1.57%)patients were re-hospitalized within 30 days after discharge.The remaining patients had no significant adverse events during the 30-day follow-up.The average length of hospital stay was 2.27±0.35 d.The length of hospital stay was over 48 h in 48(12.53%)patients.The independent risk factor for delayed discharge was lobectomy or combined resection(OR=3.015,95%CI 1.174-7.745,P=0.022).Conclusion VATS can be safely conducted under the centralized management in Day Care Unit.The risk factor for delayed discharge is the extent of surgical resection.

关 键 词：日间手术 胸腔镜手术 快速康复外科 延迟出院 

分 类 号：R614[医药卫生—麻醉学]