摘要
目的评估胸腔镜肺部手术中呼气末正压(positive end-expiratory pressure,PEEP)水平与术后肺部并发症(postoperative pulmonary complications,PPCs)的相关性。方法回顾性分析四川大学华西医院2022年1月—2023年6月行择期胸腔镜肺部手术患者的临床资料。根据术中PEEP水平将患者分为2组:PEEP 5 cm H_(2)O组和PEEP 10 cm H_(2)O组。采用最邻近匹配法,按照1∶1比例进行配对,设置卡钳值为0.02,比较匹配后两组患者PPCs发生率。结果共筛选538例患者,倾向性评分匹配后,共匹配229对(458例)患者,平均年龄53.9岁,女性占69.4%(318/458)。术后共118例(25.8%)患者住院期间发生PPCs,其中PEEP 5 cm H_(2)O组60例(26.2%),PEEP 10 cm H_(2)O组58例(25.3%),两组差异无统计学意义[OR=0.997,95%CI(0.495,1.926),P=0.915]。多因素logistic回归分析显示,PEEP不是PPCs的独立危险因素[OR=0.920,95%CI(0.587,1.441),P=0.715]。结论胸腔镜肺手术患者术中PEEP(5 cm H_(2)O或10 cm H_(2)O)与术后住院期间PPCs发生风险无显著相关性,尚需前瞻性、大样本随机对照研究进一步验证。
Objective To evaluate the correlation between positive end-expiratory pressure(PEEP)level and postoperative pulmonary complications(PPCs)in patients undergoing thoracoscopic lung surgery.Methods The clinical data of patients who underwent elective thoracoscopic lung surgery at West China Hospital of Sichuan University from January 2022 to June 2023 were retrospectively analyzed.Patients were divided into 2 groups according to intraoperative PEEP levels:a PEEP 5 cm H_(2)O group and a PEEP 10 cm H_(2)O group.The incidence of PPCs in the two groups after matching was compared using a nearest neighbor matching method with a ratio of 1∶1,setting the clamp value as 0.02.Results A total of 538 patients were screened,and after propensity score-matching,a total of 229 pairs(458 patients)were matched,with an average age of 53.9 years and 69.4%(318/458)females.A total of 118(25.8%)patients had PPCs during hospitalization after surgery,including 60(26.2%)patients in the PEEP 5 cm H_(2)O group and 58(25.3%)patients in the PEEP 10 cm H_(2)O group,with no statistically significant difference between the two groups[OR=0.997,95%CI(0.495,1.926),P=0.915].Multivariate logistic regression analysis showed that PEEP was not an independent risk factor for PPCs[OR=0.920,95%CI(0.587,1.441),P=0.715].Conclusion For patients undergoing thoracoscopic lung surgery,intraoperative PEEP(5 cm H_(2)O or 10 cm H_(2)O)is not associated with the risk of PPCs during hospitalization after surgery,which needs to be further verified by prospective,large-sample randomized controlled studies.
作者
张功伟
刘红梅
张宏伟
余海
ZHANG Gongwei;LIU Hongmei;ZHANG Hongwei;YU Hai(Department of Anesthesiology,West China Hospital,Sichuan University,Chengdu,610041,P.R.China;Department of Anesthesiology,The First People's Hospital of Shuangliu District,West China(Airport)Hospital,Sichuan University,Chengdu,610200,P.R.China;Department of Anesthesiology,West China Fourth Hospital,Sichuan University,Chengdu,610044,P.R.China;Department of Anesthesiology,Tumor Hospital of Sichuan Province,Chengdu,610041,P.R.China)
出处
《中国胸心血管外科临床杂志》
CSCD
北大核心
2024年第5期702-709,共8页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
关键词
呼气末正压
单肺通气
胸腔镜手术
肺切除术
术后肺部并发症
倾向性评分匹配
Positive end-expiratory pressure
one-lung ventilation
video-assisted thoracoscopic surgery
pneumonectomy
postoperative pulmonary complications
propensity score-matching analysi
