自发性气胸胸腔镜手术后肺部并发症的危险因素分析

Logistic regression analysis of risk factors for pulmonary complications after thoracoscopic surgery for spontaneous pneumothorax

目的探讨自发性气胸(Spontaneous pneumothorax,SP)患者行胸腔镜手术后肺部并发症的发生情况,分析其影响因素。方法选取2015年7月至2018年9月行胸腔镜手术的SP患者271例,将术后出现肺部并发症者分为并发症组,其余患者分为无并发症组。统计两组患者的性别、年龄、体质量指数(Body mass index,BMI)、吸烟史、气胸发作次数、术前合并症、胸膜黏连程度、肺大疱数目等相关资料,进行组间单因素分析和多因素Logistic回归分析。结果 (1)271例SP患者行胸腔镜术后,共发生肺部并发症29例,包括肺部感染7例,肺漏气5例,胸腔积液1例,肺膨胀不全16例;总发生率为10.70%。(2)单因素分析显示,两组患者的性别、BMI、气胸发作次数、合并心脏病等情况比较,差异均无统计学意义(P>0.05);但年龄、吸烟史、合并肺部疾病、胸膜黏连程度和肺大疱数量等相关因素相比,组间差异有统计学意义(P<0.05)。(3)Logistic回归分析显示,年龄(OR=1.891)、合并肺部疾病(OR=2.563)、肺大疱数量>2个(OR=3.782)、严重的胸膜黏连(OR=1.956),均是胸腔镜术后出现肺部并发症的独立危险因素。结论年龄偏大、术前合并肺部疾病、肺大疱数量>2个、伴有严重的胸膜黏连,均是SP患者行胸腔镜术后出现肺部并发症的危险因素之一。此类患者在术前评估中应予以重视,提高术中操作技巧并重视术后观察,以期降低其术后并发症的发生率。

Objective To investigate the incidence of pulmonary complications in patients with spontaneous pneumothorax(SP)after thoracoscopic surgery and to analyze the related factors.Methods A total of 271 patients with SP who underwent thoracoscopic surgery from July 2015 to September 2018 were randomly selected.The patients with pulmonary complications after thoracoscopic surgery were chosen as complications group and the others as non-complications group.Gender,age,body mass index(BMI),smoking history,frequency of pneumothorax attacks,preoperative complications,degree of pleural adhesions,number of bullae and other related data of the two groups were analyzed.Univariate analysis and multivariate logistic regression analysis were performed.Results (1)There were 29 cases of pulmonary complications after thoracoscopic surgery in 271 patients with SP,including 7 cases of pulmonary infection,5 cases of pulmonary leakage,1 case of pleural effusion and 16 cases of pulmonary insufficiency.The total incidence was 10.70%.(2)Univariate analysis showed that there were no significant differences in gender,BMI,frequency of pneumothorax attacks and combined heart disease between the two groups(P>0.05),but there were significant differences in age,smoking history,combined lung disease,pleural adhesion and the number of bullae between the two groups(P<0.05).(3)Logistic regression analysis showed that age(OR=1.891),pulmonary disease(OR=2.563),number of bullae>2(OR=3.782),and severe pleural adhesions(OR=1.956)were independent risk factors for pulmonary complications after thoracoscopic surgery.Conclusion Older age,preoperative pulmonary diseases,more than 2 bullae and severe pleural adhesion are all risk factors for pulmonary complications in SP patients after thoracoscopic surgery.In order to reduce the incidence of postoperative complications,attention should be paid to preoperative evaluation,intraoperative skills and postoperative observation.