摘要
目的筛选胸腔镜肺切除术后肺部并发症(PPCs)的危险因素并评价其预测价值。方法通过电子病历系统获取患者围术期资料。记录患者术后24 h内血常规并计算全身免疫炎症指数(SII)。术后2 d至出院, 根据患者是否发生PPCs将其分为非PPCs组和PPCs组。将组间比较差异有统计学意义的因素进行多元logistic回归分析, 筛选PPCs的危险因素, 以ROC曲线评价危险因素的预测效能。结果共纳入患者699例, 其中非PPCs组620例, PPCs组79例。多元logistic回归分析结果显示:BMI≥25 kg/m^(2)、ASA分级Ⅲ级、肺段切除、肺叶及以上切除、多孔胸腔镜手术和术后SII升高是PPCs发生的独立危险因素(P<0.05或0.01)。术后SII预测PPCs的AUC (95%CI)为0.636(0.599~0.671)(P<0.05), 其预测截断值为1 052.3, 灵敏度和特异度分别为68.4%和57.3%。结论 BMI≥25 kg/m^(2)、ASA分级Ⅲ级、肺段切除、肺叶及以上切除、多孔胸腔镜手术和术后SII升高是PPCs发生的独立危险因素。术后SII可在一定程度上预测胸腔镜肺切除术患者PPCs的发生。
Objective To identify the risk factors for postoperative pulmonary complications(PPCs)after thoracoscopic lung resection and evaluate the predictive value for the development of PPCs.Methods The perioperative data of patients,aged≥18 yr,of American Society of Anesthesiologists(ASA)physical statusⅠ-Ⅲ,were obtained through the electronic medical record system.The blood routine within 24 h after surgery was recorded,and systemic immune-inflammation index(SII)was calculated.According to the development of PPCs,the patients were divided into non-PPCs group and PPCs group.Multivariate logistic regression analysis was used to analyze the variables of which P values were less than 0.05 to identify the risk factors for PPCs,and the receiver operating characteristic curve was drawn to evaluate the predictive value of risk factors.Results A total of 699 patients were enrolled in this study,including 620 patients in non-PPCs group and 79 patients in PPCs group.The results of logistic regression analysis found that body mass index≥25 kg/m^(2),ASA physical statusⅢ,lung segmental resection,resection of lobes or above,multi-port thoracoscopic surgery and increased postoperative SII were the risk factors for PPCs(P<0.05 or 0.01).The AUC(95%confidence interval)of postoperative SII in predicting PPCs was 0.636(0.599-0.671)(P<0.05),the cut-off value of SII in predicting PPCs was set at 1052.3,and the sensitivity and specificity were 68.4%and 57.3%,respectively.Conclusions Body mass index≥25 kg/m^(2),ASA physical statusⅢ,lung segmental resection,resection of lobes or above,multi-port thoracoscopic surgery and increased postoperative SII are the risk factors for PPCs.Postoperative SII can predict the occurrence of PPCs to a certain extent in the patients undergoing thoracoscopic lung resection.
作者
尚凯茜
金亮
张功伟
李雪霏
余海
Shang Kaixi;Jin Liang;Zhang Gongwei;Li Xuefei;Yu Hai(Department of Anesthesiology,West China Hospital,Sichuan University,Chengdu 610041,China;Department of Anesthesiology,Hospital of Chengdu Office of People′s Government of Tibetan Autonomous Region(West China Hospital Sichuan University Tibet Chengdu Branch Hospital),Chengdu 610041,China;Department of Anesthesiology,Leshan People′s Hospital,Leshan 614000,China;Department of Anesthesiology,The First People′s Hospital of Shuangliu District(West China Airport Hospital Sichuan University),Chengdu 610200,China)
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2022年第7期823-826,共4页
Chinese Journal of Anesthesiology
基金
西藏自治区自然科学基金(XZ202101ZR0049G)。
关键词
胸腔镜检查
肺切除术
肺
手术后并发症
危险因素
预测
Thoracoscopy
Pneumonectomy
Lung
Postoperative complications
Risk factors
Forecasting
