青年肺癌患者术后快速恢复的影响因素分析

Analysis of influencing factors for rapid postoperative recovery of young lung cancer patients

目的探讨青年(≤40岁)肺癌患者术后快速恢复的影响因素。方法回顾性分析郑州大学第一附属医院胸外科2013年3月至2019年3月收治的82例经术后病理确诊的青年肺癌患者,按术后住院≤7天和>7天分为两组,收集病史及术前检查资料、术式和包埋材料、术后相关并发症及术后治疗等资料,分析各种因素与患者术后住院时间的关系。单因素分析采用t检验或Fisher确切概率法,多因素分析采用logistic回归模型,对数据进行分析。结果82例患者均成功完成手术,无围术期死亡。两组患者在术前肺功能、手术史、高血压病史、糖尿病病史、术前化疗史,术中患者体位、输血、胸膜粘连、捷力特、奈维、生物胶的使用、手术时间、肿瘤最大径,术后热灌注、发热、呕吐、呛咳、腹胀等方面差异均无统计学意义(P>0.05);而在术前抗生素使用(P=0.002)、改善肺功能(P=0.018)、吸烟史(P=0.024)、就诊原因(P=0.011),术中的术式(P<0.001)、切除范围(P<0.001)、淋巴结清扫(P=0.017)、止血粉使用(P=0.023)、失血量(P=0.001),术后白细胞计数(P=0.033)方面差异有统计学意义。结论术前、术后预防性使用抗生素及改善肺功能药物有利于患者术后恢复;吸烟是延长患者术后住院时间的独立危险因素;微创操作及运用止血材料可有效缩短患者术后住院时间。

Objective To explore the influencing factors of rapid postoperative recovery in young(≤40 years old)lung cancer patients.Methods Retrospective analysis was performed on 82 young patients with lung cancer diagnosed by postoperative pathology admitted to the department of thoracic surgery of the first affiliated hospital of Zhengzhou University from March 2013 to March 2019,the patients were divided into two groups according to their postoperative hospitalization time(hospitalization time≤7d,hospitalization time>7d).The preoperative medical history and examination data,intraoperative(operative method,embedding materials),postoperative complications and postoperative treatment and other data of the enrolled patients were collected to analyze the relationship between various factors and postoperative hospitalization time.Univariate analysis used t test or Fisher exact probability method,multivariate analysis used logistic regression model to analyze the data.Results All 82 patients successfully completed the operation,and no death occurred during the perioperative period.There were no significant differences(P>0.05)according to the two groups of patients in the preoperative pulmonary function(FEV1)operation history,history of hypertension,diabetes,history of preoperative chemotherapy and surgery in the patients'position,blood transfusion,pleural adhesion,Czech,nai d,the use of xanthan gum,operation time,the maximum diameter and postoperative tumor thermal perfusion,fever,vomiting,choking cough,abdominal distension,etc.And it has significant differences(P<0.05).In the preoperative antibiotic use(P=0.002),the improvement of lung function(P=0.018),smoking history(P=0.024),medical reasons(P=0.011)and the operation(P<0.001),the lymph node excision scope(P<0.001),the lymph node dissection(P=0.017),hemostatic material use(P=0.023),blood loss(P=0.001)and postoperative average white blood cell count(P=0.033).Conclusion Preoperative and postoperative prophylactic use of antibiotics and drugs to improve pulmonary function were beneficial to postoperative recovery.Smoking was an independent risk factor for prolonged postoperative hospital stay.Minimally invasive operation and application of hemostatic materials can effectively shorten the postoperative hospitalization time of patients.