胸腔镜下肺癌根治术患者术后心脏并发症的影响因素分析

Analysis of the influencing factors of postoperative cardiac complications in lung cancer patients underwent thoracoscopic radical resection

目的探讨胸腔镜下肺癌根治术患者术后心脏并发症的影响因素。方法选取2018年1月至2020年1月于陆军军医大学第一附属医院行胸腔镜下肺癌根治术的306例患者为研究对象,根据是否出现术后心脏并发症,将其分为心脏并发症组和无心脏并发症组。比较两组患者的临床资料,采用多因素Logistic回归分析筛选胸腔镜下肺癌根治术患者术后发生心脏并发症的影响因素。结果306例患者中共67例于术后发生心脏并发症,发生率为21.9%,发生时间:术后7 d内35例(52.2%),术后8~14 d 22例(32.8%),术后15~30 d 10例(14.9%),并发症类型:心律失常39例,心肌缺血19例,心肌梗死7例,急性心力衰竭2例。各时间段内的心脏并发症类型比较差异均无统计学意义(均P>0.05)。心脏并发症组患者年龄显著大于无心脏并发症组(P<0.05),有吸烟史、美国麻醉医师协会分级Ⅱ级、合并糖尿病和高脂血症的占比均显著高于无心脏并发症组(均P<0.05),手术时间显著长于无心脏并发症组(P<0.05),术中出血量、收缩压、甘油三酯、总胆固醇、空腹血糖、糖化血红蛋白、尿微量白蛋白均显著高于无心脏并发症组(均P<0.05),全身麻醉联合硬膜外阻滞麻醉的占比显著低于无心脏并发症组(P<0.05)。多因素Logistic回归分析结果表明年龄、麻醉方式、糖化血红蛋白、尿微量白蛋白均是胸腔镜下肺癌根治术患者术后发生心脏并发症的独立危险因素(均P<0.05)。结论胸腔镜下肺癌根治术患者术后心脏并发症发生率约为21.9%,年龄越大、糖化血红蛋白与尿微量白蛋白水平越高,术后心脏并发症的发生风险越高,采用全身麻醉联合硬膜外阻滞麻醉能降低术后心脏并发症的发生风险。

Objective To investigate the influencing factors of postoperative cardiac complications in lung cancer patients underwent thoracoscopic radical resection.Method From January 2018 to January 2020,306 patients with lung cancer underwent thoracoscopic radical resection in the First Affiliated Hospital of Third Military Medical University were selected as research objects.According to whether postoperative cardiac complications occurred,they were divided into cardiac complication group and non-cardiac complication group.The clinical data were compared between two groups,and multivariate Logistic regression analysis was performed to screen the influencing factors of postoperative cardiac complications.Result In all 306 patients,67 of them had postoperative cardiac complications,with a total incidence of 21.9%,including 35 cases(52.2%)within 7 days after operation,22 cases(32.8%)within 8~14 days after operation,10 cases(14.9%)within 15~30 days after operation.And the type of complications included 39 cases of arrhythmia,19 cases of myocardial ischemia,7 cases of myocardial infarction and 2 cases of acute heart failure.There were no significant differences in the type of cardiac complications among different time periods(all P>0.05).In cardiac complication group,the age of patients was significantly higher than that of non-cardiac complication group(P<0.05);the proportion of smoking history,American Society of Anesthesiologists gradeⅡ,diabetes mellitus and hyperlipidemia were significantly higher than those in non-cardiac complication group(all P<0.05),the operation time was significantly longer than that in non-cardiac complication group(P<0.05),intraoperative hemorrhage,systolic blood pressure,triglyceride,total cholesterol,fasting plasma glucose,glycosylated hemoglobin A1c,urinary microalbumin were significantly higher than those in non-cardiac complication group(all P<0.05),and the proportion of general anesthesia combined with epidural anesthesia was significantly lower than that in non-cardiac complication group(P<0.05).Multivariate Logistic regression analysis showed that age,anesthesia means,glycosylated hemoglobin A1c and urinary microalbumin were independent influencing factors of postoperative cardiac complications in patients underwent thoracoscopic radical resection of lung cancer(all P<0.05).Conclusion The incidence of postoperative cardiac complications in patients underwent thoracoscopic radical resection of lung cancer was about 21.9%.The higher age,glycosylated hemoglobin A1c and urinary microalbumin,the higher the risk of cardiac complications,and general anesthesia combined with epidural anesthesia could reduce the risk.