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| 肺部手术患者双侧支气管呼气末二氧化碳分压差值预测术后肺部并发症的效能 |
| Predictive effect of the difference of bilateral bronchial partial pressure of end-tidal carbon dioxide on postoperative pulmonary complications in patients undergoing lung surgery |
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| DOI：10.12089/jca.2022.08.007 |
| 中文关键词: 肺部手术 支气管呼气末二氧化碳分压 术后肺部并发症 预测 |
| 英文关键词: Lung surgery Bronchial partial pressure of end-tidal carbon dioxide Postoperative pulmonary complications Predicting |
| 基金项目:南京大学医院管理研究所课题项目（南京鼓楼医院医学发展医疗救助基金会资助项目）（NDYG2020027） |
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| 中文摘要: |
目的 评估肺部手术患者双肺的通气期间左右两侧支气管呼气末二氧化碳分压（PETCO2）差值预测术后肺部并发症（PPCs）的效能。
方法 选择择期行胸腔镜下肺部手术患者200例，男86例，女114例，年龄18～80岁，BMI 17～32 kg/m2，ASA Ⅱ或Ⅲ级。根据是否发生PPCs将患者分为两组：PPCs组和无PPCs组。测量并记录双腔支气管插管后仰卧位双肺通气后5 min（T0）、改侧卧位双肺通气后5 min（T1）、关胸后侧卧位双肺通气后5 min（T2）、术后恢复仰卧位双肺通气后5 min （T3）的气管、术侧和健侧PETCO2，计算健侧与术侧PETCO2差值（D-PETCO2）。记录单肺通气时间、手术时间、术后胸管总引流量、术后胸管留置时间和术后住院时间。采用受试者工作特征曲线(ROC)并计算曲线下面积(AUC)评估D-PETCO2预测PPCs的效能。
结果 有27例（13.5%）患者发生PPCs。与T0时比较，T1、T2时术侧PETCO2明显降低，健侧PETCO2和D-PETCO2明显升高（P<0.05）。与无PPCs组比较，PPCs组T3时D-PETCO2明显升高，单肺通气时间、手术时间、术后胸管留置时间和术后住院时间均明显延长，术后胸管总引流量明显增加（P<0.05）。T3时D-PETCO2预测PPCs的AUC为0.718（95%CI 0.614~0.879），最佳截断值为4.5 mmHg，敏感性63%，特异性90%；单肺通气时间预测PPCs的AUC为0.761（95%CI 0.655~0.867），最佳截断值为2.2 h，敏感性59%，特异性91%。
结论 肺部手术患者双肺通气期间由仰卧位改为侧卧位以及手术操作均会导致D-PETCO2明显增加，术后恢复仰卧位双肺通气后5 min的D-PETCO2和单肺通气时间可预测肺部手术患者PPCs的发生。 |
| 英文摘要: |
Objective To investigate the efficacy of the difference of bilateral bronchial partial pressure of end-tidal carbon dioxide (PETCO2) during two-lung ventilation predicting the postoperative pulmonary complications (PPCs) in patients undergoing lung surgery.
Methods A total of 200 patients scheduled for lung surgery with thoracoscopy, 86 males and 114 females, aged 18-80 years, BMI 17-32 kg/m2, and ASA physical status Ⅱ or Ⅲ were selected. Patients were divided into two groups according to whether PPCs occurred: PPCs group and non-PPCs group. PETCO2 were measured in trachea and bilateral bronchus, and the difference was calculated between the operative and healthy side of the bronchus (D-PETCO2) at 5 minutes after double lumen tube was inserted and starting bilateral lung ventilation in the supine position (T0), 5 minutes after changing to lateral position and bilateral lung ventilation (T1), 5 minutes after chest closure and bilateral lung ventilation in the lateral position (T2), 5 minutes after restoring supine position at the end of the operation and bilateral lung ventilation (T3). The duration of one lung ventilation, the duration of operation, the total drainage of chest tube, postoperative chest drainage indwelling time and the hospital length of stay were recorded. Receiver operating characteristic (ROC) curves were adopted to predict PPCs, and the area under the curve (AUC) were calculated.
Results Twenty-seven (13.5%) patients developed PPCs. Compared with the T0, PETCO2 on the surgical side was significantly decreased while PETCO2 on the healthy side and D-PETCO2 were increased significantly at T1 and T2(P < 0.05). Compared with the non-PPCs group, the value of D-PETCO2 was increased at T3, and the duration of operation, the duration of one lung ventilation were prolonged significantly in the PPCs group (P < 0.05). The AUC of D-PETCO2 at T3 was 0.718 (95% CI 0.614-0.879), and the best cut-off value was 4.5 mmHg, and the sensitivity was 63%, and the specificity was 90%. The AUC of one lung ventilation time was 0.761 (95% CI 0.655-0.867), the best cut-off value was 2.2 h, and the sensitivity was 59%, and the specificity was 91%.
Conclusion The change from supine position to lateral position and surgical operation during bilateral lung ventilation in patients undergoing lung surgery will lead to a significant increase in D-PETCO2. The value of D-PETCO2 in the supine position with two-lung ventilation for 5 minutes after lung surgery and duration of one lung ventilation can predict the PPCs in patients undergoing lung surgery. |
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