Ⅰ期非小细胞肺癌患者肺叶切除术后心肺相关并发症种类及其危险因素分析

Classification and Risk-factor Analysis of Postoperative Cardio-pulmonary Complications after Lobectomy in Patients with Stage Ⅰ Non-small Cell Lung Cancer

背景与目的随着医学技术的进步,医学检测手段的更新,体检筛查的普及以及社会健康意识的提高,越来越多的早期肺癌能够得到及时的发现并接受手术治疗,而关于患者术后并发症发生种类和高危因素的研究很少;针对I期非小细胞肺癌(non-small cell lung cancer,NSCLC)术后并发症及其高危因素的研究,可为此类患者术后心肺相关并发症的预防、干预提供依据,并加速患者康复。方法回顾性分析2012年1月-2013年12月四川大学华西医院胸外科行肺叶切除的I期NSCLC患者421例,以术后30天是否发生心肺相关并发症分为:并发症组和无并发症组。结果最终421例患者被纳入研究,其中64例为并发症组(15.2%,64/421),357例为非并发症组(84.8%,357/421)。421例患者中,发生肺部感染的比例最高(8.8%,37/421),其他主要的并发症包括肺不张(5.9%,25/421)、中量以上胸腔积液(5.0%,21/421),持续性肺漏气(3.6%,15/421)等;术前合并慢性阻塞性肺部疾病(chronic obstructive pulmonary disease,COPD)(P=0.027),术前白细胞计数(P<0.001),中性淋巴比(neutrophillymphocyte ratio,NLR)(P<0.001),术中出血量(P=0.034)以及手术时间(P=0.007)在两组间差异有统计学意义;采用二分类Logistics回归分析后发现,术前白细胞计数(OR=1.451,95%CI:1.212-1.736,P<0.001)、术前合并COPD(OR=0.031,95%CI:0.012-0.078,P<0.001)是术后发生心肺相关并发症的独立危险因素。结论术前白细胞计数以及术前合并COPD是I期肺癌患者术后心肺相关并发症发生的独立危险因素,可能可以作为预测术后心肺相关并发症的可靠指标。

Background and objective There are incresing lung cancer patients detected and diagnosed at the intermediate stage when the pre-malignant or early lesions are amenable to resection and cure, owing to the progress of medical technology, the renewal of detection methods, the popularity of medical screening and the improvement of social health consciousness. The aim of this study is to investigate the risk factors of the occurrence of postoperative cardio-pulmonary complications in stage I non-small cell lung cancer （NSCLC） patients, based on routine laboratory tests, basic characteristics, and intraoperative variables in hospital. Methods The 421 patients after lobectomy in patients with stage I NSCLC at the West China Hospital of Sichuan University from January 2012 to December 2013 were included into the study and stratified into complica- tion group and non-complication group, according to whether to occur postoperative cardio-pulmonary complications after lobectomy in 30 days. Results Of them, 64 （15.2%） patients were finally identified and selected into the complication group, compared with 357 （84.8%） in non-complication group： pneumonia （8.8%, 37/421） was the primary complication, and other main complications included atelectasis （5.9%, 25/421）, pleural effusion （_〉middle） （5.0%, 21/421）, persistent air leak （3.6%, 15/421）; The operation time （P=0.007）, amount of blood loss （P=0.034）, preoperative chronic obstructive pulmonary disease （COPD） （P=0.027）, white blood cell （WBC） count （P〈0.001）, neutrophil-lymphocyte ratio （NLR） （P〈0.001） were significantly different between the two groups. According to the binary logistics regression analysis, preoperative COPD （OR=0.031,95%CI： 0.012-0.078, P〈0.001） and W]3C count （OR= 1.451, 95%CI： 1.212-1.736, P〈0.001） were independent risk factors for postoperative cardio-pulmonary complications. Conclusion Among an array of clinical variables in hospital, operation time, preoperative white blood cell count, preoperative COPD, may be the independent risk factors of the occurrence of postoperative cardio-pulmonary complications.