新型冠状病毒感染后肺部手术时机与术后肺部并发症的关系:前瞻性队列研究

Relationship between timing of pulmonary surgery and postoperative pulmonary complications after SARS-CoV-2 infection: a prospective cohort study

目的探讨新型冠状病毒感染后肺部手术时机与术后肺部并发症(PPCs)的关系。方法采用前瞻性队列研究设计,纳入2023年1至5月择期行胸腔镜下肺部分切除术患者68例,年龄30~75岁,性别不限,ASA分级Ⅰ或Ⅱ级,BMI 18~30 kg/m2,均为2022年12月之后首次感染新型冠状病毒。依据手术日期距离新型冠状病毒感染的时间将患者分为2组(n=34):5~10周组和11~16周组。记录术前持续症状、呼吸困难情况;分别于术前1 d、术后2 h、1和2 d时采用ELISA法检测血清IL-6和TNF-α浓度;分别于术前1 d、术后1和2 d时检测WBC计数和血清CRP浓度。记录术后住院期间PPCs发生情况和术后住院时间。采用logistic回归分析PPCs与新型冠状病毒感染后肺部手术时机的关系。结果2组各有2例患者因术中转开胸手术而剔除研究,最终每组纳入32例患者。与5~10周组比较,11~16周组术前持续症状和呼吸困难比率降低,术后各时点血清IL-6、TNF-α、CRP浓度和WBC计数降低,PPCs和术后肺部感染发生率降低,术后住院时间缩短(P<0.05)。多因素logistic回归分析显示,手术日期距离新型冠状病毒感染时间短(OR=1.754,95%CI 1.509~2.038,P<0.001)、术前存在持续症状(OR=2.523,95%CI 2.047~3.110,P<0.001)、术前存在呼吸困难(OR=1.875,95%CI 1.406~2.500,P<0.001)和术后1 d时WBC计数高(OR=0.676,95%CI 0.651~0.701,P<0.001)是PPCs的独立危险因素。结论新型冠状病毒感染后11~16周相较于感染后5~10周行肺部手术PPCs风险降低;手术日期距离新型冠状病毒感染时间短是肺部手术PPCs的独立危险因素。

Objective To investigate the relationship between the timing of pulmonary surgery and postoperative pulmonary complications(PPCs)after severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection.Methods Sixty-eight American Society of Anesthesiologists Physical Status classificationⅠorⅡpatients of either sex,with body mass index of 18-30 kg/m2,who were first infected with SARS-CoV-2 after December 2022,undergoing elective thoracoscopic partial pneumonectomy from January to May 2023,were included in this prospective cohort study.The patients were divided into 2 groups(n=34 each)according to the time between the date of surgery and SARS-CoV-2 infection:5-10 weeks group and 11-16 weeks group.The preoperative persistent symptoms and dyspnea before operation were recorded.The serum concentrations of interleukin-6 and tumor necrosis factor-alpha were determined by enzyme-linked immunosorbent assay at 1 day before operation and 2 h and 1 and 2 days after operation.The white blood cell count and serum C-reactive protein concentration were measured at 1 day before operation and 1 and 2 days after operation.The occurrence of PPCs and length of postoperative hospital stay were recorded.Logistic regression was used to analyze the relationship between PPCs and timing of pulmonary surgery after SARS-CoV-2 infection.Results Two patients in each group were excluded from the study because of conversion to thoracotomy.Thirty-two patients were finally included in each group.Compared with 5-10 weeks group,the ratio of preoperative persistent symptoms and dyspnea was significantly decreased,the serum concentrations of interleukin-6,tumor necrosis factor-alpha and C-reactive protein and white blood cell count were decreased at each time point after operation,the incidence of PPCs and postoperative pulmonary infection was decreased,and the length of postoperative hospital stay was shortened in 11-16 weeks group(P<0.05).Multivariate logistic regression analysis showed that short time from the date of surgery to infection(OR=1.754,95%confidence interval[CI]1.509-2.038,P<0.001),preoperative persistent symptoms(OR=2.523,95%CI 2.047-3.110,P<0.001),preoperative dyspnea(OR=1.875,95%CI 1.406-2.500,P<0.001)and high white blood cell count at 1 day after surgery(OR=0.676,95%CI 0.651-0.701,P<0.001)were independent risk factors for PPCs.Conclusions The risk of PPCs is lower in the patients undergoing pulmonary surgery at 11-16 weeks after SARS-CoV-2 infection than at 5-10 weeks after infection.Short time from the date of surgery to infection is an independent risk factor for PPCs.