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术后肺部相关并发症(postoperative pulmonary complications,PPC)是影响肺癌病人围术期康复以及术后生活质量的重要因素[1]。肺不张、肺炎、胸腔积液、肺水肿、气胸等是心胸手术后常见的并发症,且与不良预后相关[2],如何准确地对病人进行肺功能评估,降低肺脏病人PPC的发生率成为临床医生的难题。随着技术的进步,肺超声检查在临床上的应用日益广泛,具有无创、重复性高、经济等优点,已被应用于儿童肺脏疾病[3]及危重症病人[4]的诊疗中,并有确切效果。目前国内关于肺超声评分(LUS)应用于老年病人肺部手术PPC的研究报道较少,本研究通过将肺超声检查技术应用于肺癌根治术病人,旨在分析此类病人PPC的发生率,并探讨较好的LUS干预措施。
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2组ASA分级、性别、吸烟史差异均无统计学意义(P>0.05)。PPC组总住院时间、术后住院时间、LUS均高于nPPC组(P < 0.05~P < 0.01)(见表 1)。
指标 nPPC组
(n=35)PPC组
(n=25)t P ASA Ⅱ/Ⅲ级 14/21 8/17 0.40* >0.05 年龄/岁 67.71±4.23 69.64±4.63 1.68 >0.05 男/女 7/28 9/16 1.91* >0.05 吸烟史/例 12 6 0.73* >0.05 PaO2/mmHg 79.03±3.03 78.00±3.44 1.23 >0.05 氧饱和度/% 96.26±1.22 95.56±1.73 1.84 >0.05 呼吸频率/(次/分) 17.86±1.48 18.60±1.83 1.73 >0.05 手术机械通气时间/min 157.40±29.41 153.68±19.93 0.55 >0.05 总住院时间/d 17.63±5.14 24.72±12.11 2.76 < 0.05 术后住院时间/d 7.11±2.14 13.72±7.75 4.15 < 0.01 LUS/分 12.34±1.88 14.88±2.22 4.78 < 0.01 *示χ2值 表 1 一般资料比较(x±s)
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本研究60例病人中,25例出现PPC,其中肺炎11例(44.00%),呼吸衰竭7例(28.00%),肺不张7例(28.00%),低氧血症4例(16.00%),急性呼吸窘迫综合征4例(16.00%),胸腔积液4例(16.00%),残肺端漏气2例(8.00%),支气管胸膜瘘1例(4.00%)。肺炎、呼吸衰竭、肺不张发生率最高。
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nPPC组病人的术前LUS为(12.34±1.88)分,PPC组病人的术前LUS为(14.88±2.22)分。LUS与年龄、PaO2、氧饱和度、呼吸频率、总住院时间、术后住院时间、PPC均呈正相关关系(P < 0.05~P < 0.01)(见表 2)。
指标 r P 年龄 0.316 < 0.01 ASA分级 0.106 >0.05 PO2 -0.347 < 0.01 氧饱和度 -0.280 < 0.05 呼吸频率 0.327 < 0.05 手术机械通气时间 -0.084 >0.05 总住院时间 0.312 < 0.05 术后住院时间 0.375 < 0.01 PPC 0.521 < 0.01 表 2 LUS与各项监测指标的相关性
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对2组病人之间的LUS进行ROC曲线分析,LUS预测病人发生PPC的曲线下面积为0.802[95%CI(0.690,0.914)](见图 2);根据曲线及约登指数得出,LUS的最佳临界值为12.5分,此时病人发生PPC的灵敏度及特异度分别为88.0%、57.1%。
术前肺超声评分与老年病人肺癌根治术术后肺部并发症的相关性研究
Correlation between preoperative lung ultrasound score and postoperative pulmonary complications in elderly patients undergoing radical resection of lung cancer
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摘要:
目的分析术前肺超声评分(LUS)与病人临床资料的相关性,探讨其在术后肺部并发症(PPC)预测中的作用。 方法选取60例择期行肺癌根治术的老年病人,按是否发生PPC分为2组:有并发症组(PPC组)25例和无并发症组(nPPC组)35例。术前进行肺超声检查,计算LUS;记录病人的术前氧分压(PO2)、氧饱和度、呼吸频率、手术机械通气时间、总住院时间、术后住院时间;记录PPC发生情况。分析LUS与各项监测指标的相关性;应用ROC曲线评价LUS预测病人发生PPC的价值。 结果nPPC组术前LUS为(12.34±1.88)分,PPC组术前LUS为(14.88±2.22)分,LUS与年龄、PO2、氧饱和度、呼吸频率、总住院时间、术后住院时间、PPC均呈正相关关系(P < 0.05~P < 0.01)。PPC组LUS、总住院时间、术后住院时间均高于nPPC组(P < 0.05~P < 0.01)。以LUS 12.5分预测病人发生PPC的灵敏度及特异度分别为88.0%、57.1%。 结论LUS可定量评估老年病人肺癌根治术PPC的发生,可以指导临床诊疗。 Abstract:ObjectiveTo analyze the correlation between lung ultrasound score(LUS) and clinical data of patients and explore its role in predicting postoperative pulmonary complications(PPC). MethodsSixty cases of elderly patients who underwent radical resection of lung cancer were divided into two groups: PPC group(n=25) and nPPC group(n=35) according to the PPC occurrence.Lung ultrasound examination was performed before surgery to calculate LUS.Preoperative oxygen partial pressure(PO2), oxygen saturation, respiratory rate, operation mechanical ventilation time, total hospital stay, postoperative hospital stay and the occurrence of PPC were recorded.The correlation between LUS and monitoring indicators was analyzed.ROC curve was used to evaluate the value of LUS in predicting the occurrence of PPC in patients. ResultsThe preoperative score of LUS in nPPC and PPC group was(12.34±1.88) and(14.88±2.22), respectively.LUS was positively correlated with age, PO2, oxygen saturation, respiratory rate, total length of hospital stay, postoperative length of hospital stay and PPC(P < 0.05 to P < 0.01).LUS, total hospital stay and postoperative hospital stay in PPC group was higher than that in nPPC group (P < 0.05 to P < 0.01).The point for LUS to predict the occurrence of PPC was 12.5 with the sensitivity of 88.0% and the specificity of 57.1%. ConclusionsLUS can quantitatively pre-evaluate the occurrence of PPC after radical resection of lung cancer in elderly patients, which helps to guide clinical diagnosis and treatment. -
表 1 一般资料比较(x±s)
指标 nPPC组
(n=35)PPC组
(n=25)t P ASA Ⅱ/Ⅲ级 14/21 8/17 0.40* >0.05 年龄/岁 67.71±4.23 69.64±4.63 1.68 >0.05 男/女 7/28 9/16 1.91* >0.05 吸烟史/例 12 6 0.73* >0.05 PaO2/mmHg 79.03±3.03 78.00±3.44 1.23 >0.05 氧饱和度/% 96.26±1.22 95.56±1.73 1.84 >0.05 呼吸频率/(次/分) 17.86±1.48 18.60±1.83 1.73 >0.05 手术机械通气时间/min 157.40±29.41 153.68±19.93 0.55 >0.05 总住院时间/d 17.63±5.14 24.72±12.11 2.76 < 0.05 术后住院时间/d 7.11±2.14 13.72±7.75 4.15 < 0.01 LUS/分 12.34±1.88 14.88±2.22 4.78 < 0.01 *示χ2值 表 2 LUS与各项监测指标的相关性
指标 r P 年龄 0.316 < 0.01 ASA分级 0.106 >0.05 PO2 -0.347 < 0.01 氧饱和度 -0.280 < 0.05 呼吸频率 0.327 < 0.05 手术机械通气时间 -0.084 >0.05 总住院时间 0.312 < 0.05 术后住院时间 0.375 < 0.01 PPC 0.521 < 0.01 -
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