股直肌剪切波弹性成像对胸腔镜术后肺部并发症的预测价值

Predictive value of rectus femoris shear wave elastography for postoperative pulmonary complications in thoracoscopic surgery

目的:探究股直肌剪切波弹性成像(shear wave elastography,SWE)与胸腔镜术后肺部并发症(postoperative pulmonary complication,PPC)的相关性及预测价值。方法:收集择期行胸腔镜手术的292例患者的临床资料。根据术后是否发生PPC,分为非PPC组和PPC组。两组患者术前股直肌检查均采用常规超声联合SWE,测量股直肌厚度(rectus femoris thickness,RF_(thick))、横截面积(cross-sectional area,RF_(csa))及剪切波弹性速度平均值(mean shear wave velocity,CS_(mean))。比较两组间临床资料与股直肌超声各参数的差异,并分析与PPC发生的相关性,采用二元Logistic回归分析得出联合诊断公式,绘制受试者工作特征曲线进一步分析单一指标和联合指标对PPC的预测价值。结果:PPC的发生与年龄呈正相关,与股直肌CS_(mean)呈负相关(P<0.001);年龄与股直肌CS_(mean)单独预测PPC的效能较低,两指标联合预测效能更高,曲线下面积为0.714。结论:股直肌CS_(mean)分析预测PPC的发生具有可行性,结合年龄指标预测价值更高,可无创、快速评估胸腔镜手术患者发生PPC的风险。

Objective:To explore the correlation and predictive value of shear wave elastography(SWE)of the rectus femoris with postoperative pulmonary complication(PPC)following thoracoscopic surgery.Methods:Clinical data from 292 patients scheduled for elective thoracoscopic surgery were collected.Patients were divided into the PPC group and the non-PPC group,based on the ocurrence of PPC postoperatively.Preoperative assessments of the rectus femoris included conventional ultrasound combined with SWE,measuring rectus femoris thickness(RF_(thick)),cross-sectional area(RF_(csa)),and mean share wave velocity(CS_(mean)).Differences in clinical data and the rectus femoris ultrasound parameters between the two groups were compared.The correlation with PPC occurrence was analyzed,and a combined diagnostic formula was derived using binary logistic regression analysis.ROC curves were plotted to further analyze the predictive value of single and combined indicators for PPC.Results:The occurrence of PPCs was positively correlated with age and negatively correlated with the rectus femoris CS_(mean)(P<0.001).Age and CS_(mean)alone had lower predictive efficacy for PPCs,while their combination showed higher efficacy,with the area under cure of 0.714.Conclusion:Analysis of the rectus femoris CS_(mean)is feasible for predicting the occurrence of PPCs,and its predictive value is enhanced when combined with age.This non-invasive and rapid assessment can evaluate the risk of PPC in patients undergoing thoracoscopic surgery.