快速康复病房腔镜下肺结节切除术患者术后肺部并发症危险因素分析  

Analysis of risk factors for postoperative pulmonary complications in patients undergoing video⁃assisted thoracic surgery under day surgery management model

作　　者：倪爽 路子蕴 孙行 史敏科[4] 张楼乾 杨如松 李冰冰 NI Shuang;LU Ziyun;SUN Hang;SHI Minke;ZHANG Louqian;YANG Rusong;LI Bingbing(Nanjing Drum Tower Clinical College of Nanjing Medical University,Nanjing 210008;Department of Anesthesia Surgery,Nanjing Central Hospital,Nanjing 210018;Department of Anesthesia Surgery,Nanjing Drum Tower Hospital,Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China;Department of Cardiothoracic Surgery,Nanjing Drum Tower Hospital,Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京医科大学鼓楼临床医学院,江苏南京210008 [2]南京市中心医院麻醉科,江苏南京210018 [3]南京大学医学院附属鼓楼医院麻醉手术科,江苏南京210008 [4]南京大学医学院附属鼓楼医院心胸外科,江苏南京210008

出　　处：《南京医科大学学报(自然科学版)》2025年第1期48-55,共8页Journal of Nanjing Medical University(Natural Sciences)

基　　金：江苏省第六期“333高层次人才培养工程”(20223-1-244)。

摘　　要：目的:分析快速康复病房行胸腔镜下肺结节切除术的患者发生术后肺部并发症(postoperative pulmonary complication,PPC)的危险因素。方法:回顾性分析快速康复病房管理模式下首次行胸腔镜下肺结节切除术的624例患者的临床资料。根据患者出院后1个月内是否发生PPC分为PPC组和非PPC组。通过多因素Logistic回归分析筛选出独立危险因素,构建列线图预测模型并进行内部验证。结果:209例(33.5%)患者发生PPC。多因素Logistic回归分析结果显示,术后胸腔引流管放置天数(OR=1.478,95%CI:1.043~2.094)、术后第1天引流量(OR=1.008,95%CI:1.006~1.011)、病理结果为恶性(OR=1.564,95%CI:1.037~2.359)是PPC的独立危险因素。预测模型受试者工作特征曲线下面积为0.716(95%CI:0.673~0.760),基于Hosmer-Lemeshow检验的校准曲线P值为0.105,提示预测模型区分度和校准度均较好。结论:术后胸腔引流管放置天数、术后第1天引流量、病理结果为恶性是快速康复病房管理模式下行胸腔镜肺结节切除术患者发生PPC的独立危险因素,且根据其构建的预测模型有较好的区分度和校准度,可为防治术后发生PPC提供个体化依据。Objective:To analyze the risk factors of postoperative pulmonary complication(PPC)in patients undergoing video-assisted thoracic surgery(VATS)under day surgery management model.Methods:The clinical data of 624 patients who underwent the surgery of thoracoscopic pulmonary nodules for the first time in the Rapid Rehabilitation Care Unit were retrospectively analyzed.Patients were divided into two groups based on whether they developed PPC within one month after discharge:the PPC group and the non-PPC group.Multivariate logistic regression analysis were performed to identify independent risk factors,and a nomogram prediction model was constructed and internally validated.Results:A total of 209 patients(33.5%)developed PPC.Multivariate logistic analysis showed that days of postoperativie thoracic drainage tube placement(OR=1.478,95%CI:1.043-2.094),drainage volume on the first day after surgery(OR=1.008,95%CI:1.006-1.011),and malignant pathological results(OR=1.564,95%CI:1.037-2.359)were independent risk factors for PPC.The area under the ROC curve of the prediction model was 0.716(95%CI:0.673-0.760),and the calibration curve based on the Hosmer-Lemeshow test had a P-value of 0.105,suggesting good discrimination and calibration of the prediction model.Conclusion:The days of postoperative thoracic drainage tube placement,the drainage volume on the first day after surgery and malignant pathological results are independent risk factors for PPC in patients undergoing VATS under day surgery management model.The prediction model constructed based on these factors shows good discrimination and calibration,providing a basis for personalized prevention and treatment of postoperative PPC.

关 键 词：胸腔镜手术 快速康复病房 肺部并发症 回顾性分析 危险因素 

分 类 号：R734.2[医药卫生—肿瘤]