探讨肺癌患者胸腔镜肺切除术后肺部并发症发生的影响因素

Influencing factors of pulmonary complications after thoracoscopic pneumonectomy in patients with lung cancer

目的:将心肺运动试验(CPET)与临床指标相结合评估肺癌患者胸腔镜肺切除术后肺部并发症(PPCs)的影响因素。方法:回顾性分析我院胸外科行胸腔镜(VATS)肺切除手术的肺癌患者,收集患者的基线资料、CPET及临床相关数据,通过单因素分析、Logistics多因素分析和受试者工作特征曲线(ROC),找出PPCs发生的影响因素,并进行量化与验证。结果:共纳入患者95例,其中并发症组30例(31.6%),非并发症组65例(68.4%)。单因素分析结果示:PPCs与年龄>62岁、术中出血量>100mL、患有冠心病、功率(work)、峰值摄氧量(peak VO 2)、峰值摄氧量占预计值百分比(peak VO 2%pred)、峰值公斤摄氧量(peak VO 2/kg)、氧脉搏(peak VO 2/HR)、氧脉搏占预计值百分比(peak VO 2/HR%pred)均显著相关(均P<0.05),并发症组术后住院时间>10d的患者明显多于非并发症组。多因素分析结果示:年龄>62岁、身体质量指数(BMI)<22.5kg/m 2、出血量>100ml和peak VO 2/HR%pred是VATS肺切除术PPCs发生的独立影响因素(均P<0.05),其余因素均无统计学意义。PPCs影响因素的ROC曲线分析,结果示曲线下面积(AUC)为0.836,对PPCs预测的灵敏度为93.33%,特异度为63.08%(95%CI:0.746~0.904)。结论:年龄>62岁、BMI<22.5kg/m 2、出血量>100ml和peak VO 2/HR%pred作为PPCs发生的独立影响因子可以很好的预测PPCs的发生,较高的BMI可能是PPCs发生的保护因素。

Objective:Cardiopulmonary exercise test(CPET)was combined with clinical indicators to evaluate the influencing factors of pulmonary complications(PPCs)after thoracoscopic surgery in patients with lung cancer.Methods:Retrospective analysis was performed on the information of patients with lung cancer who underwent video-assisted thoracic surgery(VATS)pneumonectomy in the thoracic surgery department.The baseline data,CPET and clinically relevant data of patients were collected,and the influencing factors of PPCs were found through unifactorial analysis,Logistics multi-factor analysis and receiver operating characteristic curve(ROC),and quantified and verified.Results:A total of 95 patients were included,including 30 patients in the complication group(31.6%)and 65 patients in the non-complication group(68.4%).Univariate analysis results showed that PPCs were significantly correlated with age of>62 years old,intraoperative blood loss of>100 mL,coronary heart disease work,peak VO 2,peak VO 2%pred,peak VO 2/Kg,VE/VCO 2 slope,peak VO 2/HR,peak VO 2/HR%pred(all P<0.05).Patients in the complication group had significantly longer postoperative hospital stay(>10 days)than that in the non-complication group.Multivariate analysis results showed:age>62 years old,bady mass index(BMI)<22.5 kg/m 2,blood loss>100 mL and peak VO 2/HR%pred were independent influencing factors of PPCs in VATS pneumonectomy,while the other factors had no statistical significance.The ROC curve analysis of the influencing factors of PPCs showed that the area under the ROC curve(AUC)was 0.836,the sensitivity and specificity of PPCs prediction were 93.33%and 63.08%,respectively(95%CI:0.746-0.904).Conclusions:Age>62,BMI<22.5 kg/m 2,blood loss>100 mL and peak VO 2/HR%pred,as independent influencing factors for the occurrence of PPCs,can well predict the occurrence of PPCs,and higher BMI may be a protective factor for the occurrence of PPCs.