肺结节患者术后延迟出院的危险因素分析

Analysis of risk factors for delayed postoperative discharge of patients with pulmonary nodules

目的 探讨肺结节手术患者术后延迟出院的影响因素。方法 回顾性分析2021年6月至8月东部战区总医院因肺结节全麻下行胸腔镜/达芬奇机器人手术患者223例的电子病历资料,其中男91例,女132例。采用单因素分析和二元logistic回归分析筛选肺结节患者术后延迟出院的危险因素。结果 以术后住院时间≥3 d的159例(71.3%)患者为延迟出院组,<3 d的64例(28.7%)为正常出院组。延迟组患者的年龄、男性比例、吸烟史比例、胸腔镜手术占比、手术时长、术中补液量、术中失液量、丙泊酚使用量、术后并发症发生率、胸腔引流管留置时间及引流量明显高于正常出院组(P<0.05)。二元logistic回归分析显示,年龄大[OR=1.063,95%CI(1.016~1.111),P=0.008]、引流管留置时间长[OR=8.743,95%CI(4.144~18.445),P<0.01]以及使用常规静脉镇痛泵[OR=3.759,95%CI(1.232~11.468),P=0.020]是术后住院时长≥3 d的独立危险因素。结论 年龄大、引流管留置时间长以及使用常规静脉镇痛泵可影响肺结节手术患者术后住院时间。

Objective To investigate the influencing factors of delayed postoperative discharge in patients with pulmonary nodules.Methods Electronic medical records of 223 patients,91 males and 132 females,who underwent thoracoscopic/Da Vinci robotic surgery for pulmonary nodules under general anesthesia in Eastern Theater General Hospital,from June to August 2021 were analyzed retrospectively.Univariate analysis and binary logistic regression analysis were used to screen the risk factors for delayed postoperative discharge in patients with pulmonary nodules.Results One hundred and fifty-nine patients(71.3%)with a postoperative hospital stay of≥3 days were considered the delayed discharge group,and the 64 patients(28.7%)with<3 days were considered the normal discharge group.The age,proportion of males,proportion of smoking history,proportion of thoracoscopic surgery,operation duration,intraoperative fluid supplement and fluid loss volume,propofol consumption,incidence of postoperative complications,duration of thoracic drainage tube retention,and drainage volume of patients in the delayed discharge group were significantly higher than those in the normal discharge group(P<0.05).Binary logistic regression analysis showed that older age[OR=1.063,95%CI(1.016-1.111),P=0.008],longer duration of thoracic drainage tube retention[OR=8.743,95%CI(4.144-18.445),P<0.01]and use of conventional intravenous analgesic pump[OR=3.759,95%CI(1.232-11.468),P=0.020]were independent risk factors for the postoperative hospital stay≥3 days.Conclusion Older age,longer duration of thoracic drainage tube retention and use of conventional intravenous analgesic pump can affect the length of postoperative hospitalization in patients undergoing lung nodule surgery.