肺癌患者胸腔镜术后心肺并发症的相关因素分析

Correlative factors analysis of cardiopulmonary complications in patients with lung cancer after thoracoscopy

目的分析肺癌患者胸腔镜术后心肺并发症的种类及相关影响因素。方法对2013年3月—2016年3月河南大学第一附属医院胸外科收治394例肺癌患者临床资料进行回顾性分析。结果 394例肺癌患者,按手术30 d是否发生心肺并发症进行分组,61例为并发症组,占15.48%(61/394),333例为无并发症组,占84.52%(333/394)。394例肺癌患者,以肺部感染发生率最高,为8.88%(35/394),其他主要并发症肺不张发生率为5.84%(23/394),胸腔积液发生率为5.08%(20/394),持续性肺漏气发生率为3.55%(14/394)等。术前合并慢性阻塞性肺疾病(COPD)、术前合并冠心病、术前白细胞计数(WBC)、术前中性粒细胞与白细胞比值(NLR)、手术时间、术中出血量、术后抗生素使用时间、术后住院时间在并发症组与无并发症组间差异存在统计学意义(P<0.05)。经Logistic回归分析显示,术前WBC、术前合并冠心病、术前合并COPD为患者术后心肺并发症的独立危险因素。结论术前WBC、术前合并冠心病、术前合并COPD为肺癌患者胸腔镜术后心肺并发症发生的独立危险因素,或许有助于预测术后心肺并发症发生,为围术期防治工作提供指导。

Objective To analyze correlative factors of cardiopulmonary complications in patients with lung cancer after thoracoscopy. Methods From Mar. 2014 to Mar. 2016,a total of 394 patients with lung cancer in our hospital were taken as the clinical research objects. Results Thirty days after thoracoscopy,they were divided into complication group（61 cases,15. 48%） and no complication group（333 cases,84. 52%）. The incidence rates of pulmonary infection,atelectasis,pleural effusion and persistent pulmonary leakage were respectively 8. 88%（35/394）,5. 84%（23/394）,5. 08%（20/394） and 3. 55%（14/394）. There were significant differences between complication group and no complication group in preoperative concurrent chronic obstructive pulmonary disease（COPD）,preoperative concurrent coronary heart disease,preoperative white blood cell count（WBC）,preoperative neutrophil and leukocyte ratio（NLR）,operation time,intraoperative blood loss,postoperative antibiotic use time and postoperative hospital stay（P〈0. 05）. Logistic regression analysis showed that preoperative WBC,preoperative concurrent coronary heart disease and preoperative concurrent COPD were independent risk factors for postoperative cardiopulmonary complications. Conclusion Preoperative WBC,preoperative concurrent coronary heart disease and preoperative concurrent COPD are independent risk factors for cardiopulmonary complications in patients with lung cancer after thoracoscopy. It may be helpful to predict postoperative cardiopulmonary complications,and provide guidance for perioperative prevention and control work.