文章摘要
张耀莹,李瑾,高民,张淼,张明,陈伟.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[J].中国康复,2021,36(6):348-352
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
  
DOI:
中文关键词: 心肺运动试验  非小细胞肺癌  术后肺部并发症
英文关键词: cardiopulmonary exercise test  non-small cell lung cancer  postoperative pulmonary complications
基金项目:徐州市引进临床医学专家团队项目(2018TD007);徐州市科技计划项目(KC18184);徐州市科技计划项目(KC20136)
作者单位
张耀莹 徐州医科大学附属徐州康复医院江苏 徐州 221004 
李瑾 徐州市中心医院江苏 徐州 221009 
高民 徐州市中心医院江苏 徐州 221009 
张淼 徐州市中心医院江苏 徐州 221009 
张明 徐州医科大学附属徐州康复医院江苏 徐州 221004 
陈伟 徐州市中心医院江苏 徐州 221009 
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中文摘要:
  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 VO2)、峰值摄氧量占预计值百分比(peak VO2%pred)、峰值公斤摄氧量(peak VO2/kg)、氧脉搏(peak VO2/HR)、氧脉搏占预计值百分比(peak VO2/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/m2、出血量>100ml和peak VO2/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/m2、出血量>100ml和peak VO2/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。
英文摘要:
  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 VO2, peak VO2%pred, peak VO2/Kg, VE/VCO2 slope, peak VO2/HR, peak VO2/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/m2, blood loss >100 mL and peak VO2/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/m2, blood loss >100 mL and peak VO2/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.
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