胸腔镜部分肺切除术后肺部并发症的危险因素

Risk factors analysis of postoperative pulmonary complications after thoracoscopic partial lung resection

目的探讨胸腔镜部分肺切除术后肺部并发症(PPCs)的危险因素。方法回顾性分析2018年1—12月首次行胸腔镜解剖性部分肺切除手术患者896例,年龄18~79岁,ASAⅠ—Ⅲ级,术前所有患者肺功能正常。收集患者性别、年龄、BMI、合并症、术中出入量及PPCs等围术期资料。采用单因素分析及多因素Logistic回归分析法筛选胸腔镜部分肺切除PPCs的危险因素。结果有220例(24.6%)患者发生PPCs(并发症组),其中最常见的肺炎有135例(15.1%)。单因素分析显示,并发症组患者术前白蛋白<35 g/L、右肺手术、多肺叶肺段手术的比例明显高于无并发症组(P<0.05),单肺通气时间明显长于无并发症组(P<0.05),液体入量明显少于无并发症组(P<0.05)。多因素Logistic回归分析显示,单肺通气时间>2 h(OR=1.605,95%CI 1.113~2.314,P=0.011)、白蛋白<35 g/L(OR=1.806,95%CI 1.094~2.981,P=0.021)、右肺手术(OR=1.443,95%CI 1.043~1.998,P=0.027)、多肺叶肺段手术(OR=1.998,95%CI 1.348~2.932,P=0.001)是胸腔镜部分肺切除PPCs的独立危险因素。结论单肺通气时间延长(>2 h)、低白蛋白血症(白蛋白<35 g/L)、右肺手术及接受多肺叶肺段手术可作为胸腔镜部分肺切除PPCs的独立危险因素。

Objective To investigate the risk factors of postoperative pulmonary complications(PPCs) after thoracoscopic partial lung resection. Methods A total of 896 patients who underwent thoracoscopic anatomical pneumonectomy for the first time between January and December 2018 were enrolled, aged 18-79 years, ASA physical statusⅠ-Ⅲ, with normal pulmonary function. The data of gender, age, BMI, complications, intraoperative volume and PPCs were recorded. Univariate analysis and multivariate logistic regression analysis were used to screen the risk factors of postoperative pulmonary complications after thoracoscopic anatomical pneumonectomy. Results Among the 896 patients, there were 220 cases(24.6%) of PPCs and 135 cases(15.1%) of pneumonia. Univariate analysis showed that the proportion of hypoalbuminemia, right pneumonectomy and multi lobectomy in the PPCs group was higher than that in the non PPCs group(P < 0.05), the time of one lung ventilation was longer than that in the non PPCs group(P < 0.05), and the liquid intake was less than that in the non PPCs group(P < 0.05). Logistic regre￣ssion analysis showed that the time of single-lung ventilation > 2 h(OR = 1.605, 95% CI 1.113-2.314, P = 0.011), hypoalbuminemia(OR = 1.806, 95% CI 1.094-2.981, P = 0.021), bilobectomy or combined lobectomy and segmentectomy(vs single lobectomy)(OR = 1.998, 95% CI 1.348-2.932, P = 0.001), and right lung lobe surgery(vs left lung lobe surgery)(OR = 1.443, 95% CI 1.043-1.998, P = 0.027) were independent risk factors for PPCs. Conclusion Long-time one lung ventilation(> 2 h), hypoalbuminemia(< 35 g/L), right lung operation and multi-segmental lobectomy are independent risk factors for pulmonary complications after thoracoscopic partial lung resection.