老年患者CT引导下经皮肺穿刺活检气胸发生情况及影响因素分析  

Analysis of the incidence and influencing factors of pneumothorax in elderly patients undergoing CT-guided percutaneous lung biopsy

作　　者：别志欣[1] 郭润碛 李彬 王承恩 徐圣 李元明[1] 李晓光[1] Bie Zhixin;Guo Runqi;Li Bin;Wang Chengen;Xu Sheng;Li Yuanming;Li Xiaoguang(Minimally Invasive Tumor Therapies Center,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京医院肿瘤微创治疗中心、国家老年医学中心、中国医学科学院老年医学研究院,北京100730

出　　处：《中华老年医学杂志》2024年第12期1575-1580,共6页Chinese Journal of Geriatrics

基　　金：中国医学科学院临床与转化医学研究专项2023(2023-I2M-C&T-A-013)。

摘　　要：目的探讨CT引导下经皮肺穿刺活检(PLB)老年患者(≥65岁)气胸的发生率及影响因素。方法前瞻性队列研究,连续纳入2017年1月至2023年12月在北京医院接受CT引导下PLB的老年患者,在术后即刻和PLB后48 h进行两次CT扫描来评估气胸的发生情况,根据是否发生气胸分为气胸组和非气胸组,比较两组的基线临床和手术资料,多因素logistic回归分析确定气胸发生的影响因素。结果647例行PLB的老年患者中,气胸有152例(23.5%、152/647),包括少量气胸101例(15.6%)、大量气胸51例(7.9%)。与非气胸组比较,气胸组的慢性阻塞性肺疾病(COPD)发生率更高、衰弱比例更高、病变更小、与胸壁距离更远、支气管受累也更多、穿刺深度≥5 cm的比例更高(均P<0.05)。多因素logistic回归分析结果显示,COPD(OR=1.256,95%CI:1.014~1.558,P=0.033)、病灶大小≤2 cm(OR=1.345,95%CI:1.075~1.659,P=0.022)、病灶距胸壁距离≥2 cm(OR=1.372,95%CI:1.105~1.703,P=0.007)、肺大疱或肺气肿(OR=1.524,95%CI:1.223~1.899,P<0.001)、病灶密度[毛玻璃影(OR=1.313,95%CI:1.072~1.839,P=0.014)]、支气管受累(OR=1.211,95%CI:1.047~1.694,P=0.038)、穿刺深度≥5 cm(OR=1.312,95%CI:1.024~1.749,P=0.038)是发生少量气胸的影响因素;而年龄(OR=1.286,95%CI:1.021~1.819,P=0.041)、COPD(OR=1.248,95%CI:1.098~1.753,P=0.035)、心力衰竭(OR=1.312,95%CI:1.027~1.956,P=0.042)、衰弱(OR=1.301,95%CI:1.063~1.981,P=0.036)、病灶大小≤2 cm(OR=1.345,95%CI:1.040~1.872,P=0.039)、病灶距胸壁距离≥2 cm(OR=1.482,95%CI:1.116~1.738,P=0.032)、肺大疱或肺气肿(OR=1.705,95%CI:1.316~2.431,P=0.024)、穿刺深度≥5 cm(OR=1.343,95%CI:1.058~1.763,P=0.037)是发生大量气胸的影响因素。结论接受CT引导下PLB的老年患者发生气胸的风险较高,需要制定个性化的预测策略降低气胸,特别是大量气胸的风险。ObjectiveTo investigate the incidence and influencing factors of pneumothorax in elderly patients(aged≥65 years)undergoing CT-guided percutaneous lung biopsy(PLB).MethodsA prospective cohort study was conducted,enrolling elderly patients who underwent CT-guided PLB at Beijing Hospital from January 2017 to December 2023.Pneumothorax occurrence was assessed through two CT scans performed immediately post-procedure and at 48 hours post-PLB.Based on pneumothorax status,patients were categorized into a pneumothorax group and a non-pneumothorax group.Baseline clinical and procedural data were compared between the two groups,and multivariate logistic regression analyses were conducted to identify factors associated with pneumothorax.ResultsAmong the 647 elderly patients who underwent PLB,152 cases(23.5%,152/647)developed pneumothorax,with 101 cases(15.6%)presenting with minor pneumothorax and 51 cases(7.9%)with major pneumothorax.Compared with the non-pneumothorax group,patients in the pneumothorax group had a higher incidence of chronic obstructive pulmonary disease(COPD),higher frailty proportion,smaller lesions,lesions located further from the chest wall,more frequent bronchial involvement,and a higher rate of puncture depth≥5 cm(all P<0.05).Multivariate logistic regression analysis revealed the following as significant risk factors for minor pneumothorax:COPD(OR=1.256,95%CI:1.014-1.558,P=0.033),lesion size≤2 cm(OR=1.345,95%CI:1.075-1.659,P=0.022),lesion-to-chest-wall distance≥2 cm(OR=1.372,95%CI:1.105-1.703,P=0.007),presence of pulmonary bullae or emphysema(OR=1.524,95%CI:1.223-1.899,P<0.001),ground-glass opacity density(OR=1.313,95%CI:1.072-1.839,P=0.014),bronchial involvement(OR=1.211,95%CI:1.047-1.694,P=0.038),and needle insertion depth≥5 cm(OR=1.312,95%CI:1.024-1.749,P=0.038).For major pneumothorax,significant risk factors included age(OR=1.286,95%CI:1.021-1.819,P=0.041),COPD(OR=1.248,95%CI:1.098-1.753,P=0.035),heart failure(OR=1.312,95%CI:1.027-1.956,P=0.042),frailty(OR=1.301,95%CI:1.063-1.981,P=0.036

关 键 词：穿刺术 经皮穿刺肺活检术 气胸 影响因素 

分 类 号：R561.4[医药卫生—呼吸系统]