胸腔镜辅助肺癌根治术后老年患者发生呼吸衰竭的风险和结果:回顾性队列研究  

Risk and outcomes of respiratory failure in elderly patients after thoracoscopic assisted radical lung cancer surgery:a retrospective cohort study

作　　者：谢忠尧[1] 姚思雨 王帆 刘秋月[2] Xie Zhongyao;Yao Siyu;Wang Fan;Liu Qiuyue(Department of Healthcare-Associated Infection Management,Beijing Chest Hospital,Capital Medical University,Beijing Tuberculosis and Thoracic Tumor Research Institute,Beijing 101149,China;Department of intensive care unit,Beijing Chest Hospital,Capital Medical University,Beijing Tuberculosis and Thoracic Tumor Research Institute,Beijing 101149,China)

机构地区：[1]首都医科大学附属北京胸科医院/北京市结核病胸部肿瘤研究所感染管理处,北京101149 [2]首都医科大学附属北京胸科医院/北京市结核病胸部肿瘤研究所重症医学科,北京101149

出　　处：《中华老年医学杂志》2024年第12期1562-1567,共6页Chinese Journal of Geriatrics

基　　金：国家自然科学基金(82100011)。

摘　　要：目的观察胸腔镜辅助肺癌根治术后发生呼吸衰竭老年患者的临床资料,发现发生呼吸衰竭的危险因素,探讨独立危险因素在预警胸腔镜辅助肺癌根治术后老年患者发生呼吸衰竭的临床价值。方法连续收集2021年1月1日至2023年12月31日于首都医科大学附属北京胸科医院胸腔镜辅助肺癌根治术后发生呼吸衰竭的老年患者42例作为观察组,同时按照1∶1比例随机抽取同期胸腔镜辅助肺癌根治手术治疗的老年肺癌术后未发生呼吸衰竭的患者作为对照组。收集两组患者临床资料并进行Logistic单因素及多因素分析。应用受试者操作特征曲线(ROC曲线)评价独立危险因素及组合的其曲线下面积(AUC),敏感性及特异性。结果糖尿病史,降钙素原(PCT)水平,术后当天入量为发生呼吸衰竭的独立危险因素,多因素分析显示糖尿病史(OR=1.29,95%CI:0.89~1.69;P=0.012)、PCT(OR=1.75,95%CI:1.51~2.38;P=0.005)、术后当天入量(OR=1.42,95%CI:1.14~1.76;P<0.001)与术后呼吸衰竭的发生相关。预测呼吸衰竭的AUC分别为0.679、0.679、0.740。糖尿病史的敏感性为41.2%,特异性为87.1%;PCT的敏感性为64.7%,特异性为64.5%;术后当天入量的敏感性为70.6%,特异性为74.2%。三种指标组合模型对呼吸衰竭进行预测,AUC值为0.918,敏感性为94.1%,特异性为80.6%。结论胸腔镜辅助肺癌根治术后老年患者有糖尿病史,PCT水平,术后当天入量对预警发生呼吸衰竭具有良好的临床应用价值。ObjectiveThis study aims to analyze the clinical data of elderly patients who experienced respiratory failure after undergoing thoracoscopic-assisted radical lung cancer surgery.The objectives are to identify the risk factors associated with respiratory failure and to investigate the clinical significance of independent risk factors for the early prediction of respiratory failure in this patient population.MethodsA total of 42 elderly patients who developed respiratory failure following thoracoscopic-assisted radical lung cancer surgery at our hospital between January 1,2021,and December 31,2023,were continuously collected to form the observation group.Concurrently,a control group was established by randomly selecting elderly lung cancer patients who did not experience respiratory failure during the same period,in a 1:1 ratio.Clinical data were collected from both groups,and logistic univariate and multivariate analyses were conducted.A receiver operating characteristic(ROC)curve was employed to evaluate the area under the curve(AUC),as well as the sensitivity and specificity of independent risk factors and their combinations.ResultsThe history of diabetes,PCT levels,and surgical day intake have been identified as independent risk factors for respiratory failure.Multivariate analysis revealed that a history of diabetes(OR:1.29,95%CI:0.89-1.69;P=0.012),PCT(OR:1.75,95%CI:1.51-2.38;P=0.005),and surgical day intake(OR:1.42,95%CI:1.14-1.76;P<0.001)were significantly associated with the occurrence of postoperative respiratory failure.The area under the curve(AUC)values for predicting respiratory failure were 0.679,0.679,and 0.740,respectively.The sensitivity and specificity for a history of diabetes were 41.2%and 87.1%;for PCT,64.7%and 64.5%;and for surgical day intake,70.6%and 74.2%.Notably,a combined model incorporating these three indicators produced an AUC of 0.918,with a sensitivity of 94.1%and a specificity of 80.6%.ConclusionsFollowing thoracoscopic-assisted radical lung cancer surgery,elderly patients with a hi

关 键 词：胸外科手术 老年人 呼吸衰竭 预警 

分 类 号：R734.2[医药卫生—肿瘤] R563.8[医药卫生—临床医学]