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| 胸腔镜肺切除术患儿术后肺部并发症的危险因素 |
| Risk factors of postoperative pulmonary complications in children after video-assisted thoracoscopic lung resection |
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| DOI：10.12089/jca.2024.01.010 |
| 中文关键词: 儿童 单肺通气 胸腔镜 肺切除术 术后肺部并发症 危险因素 |
| 英文关键词: Child One lung ventilation Thoracoscopy Lung resection Postoperative pulmonary complications Risk factors |
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| 中文摘要: |
目的：分析患儿胸腔镜下肺切除术后肺部并发症（PPCs）的危险因素。
方法：回顾性分析行胸腔镜肺切除术566例患儿的临床资料，男334例，女232例，年龄≤6岁，ASA Ⅰ或Ⅱ级。根据患者术后7 d内是否发生PPCs分为两组：PPCs组和非PPCs组。将单因素分析中P≤0.2以及临床认为可能有意义的协变量纳入多因素Logistic回归分析。绘制受试者工作特征（ROC）曲线并计算曲线下面积（AUC）。
结果：有123例（21.7%）发生PPCs。多因素Logistic回归分析显示，单肺通气时间长、单肺通气时呼吸频率快、手术医师经验不足是PPCs的独立危险因素，术中最大PEEP升高（最大为7 cmH2O）是保护因素。预测模型为Logit（P）=-4.410+0.006×单肺通气时间+0.063×单肺通气呼吸频率+0.569×手术医师经验不足（赋值为1）-0.160×最大PEEP值，该模型预测患儿胸腔镜肺切除术PPCs发生率的AUC为0.682（95%CI 0.631～0.734），敏感性76.4%，特异性69.6%。
结论：单肺通气时间长、单肺通气时呼吸频率快、手术医师经验不足是患儿胸腔镜肺切除术PPCs的危险因素，术中最大PEEP升高是PPCs的保护因素。 |
| 英文摘要: |
Objective: To investigate risk factors of postoperative pulmonary complications (PPCs) in children after video-assisted thoracoscopic lung resection.
Methods: Retrospective analysis of clinical data of 566 children, 334 males and 232 females, aged ≤ 6 years, ASA physical status Ⅰ or Ⅱ, enrolled for video-assisted thoracoscopic lung resection. The children were divided into two groups based on whether they developed PPCs within 7 days after surgery: the PPCs group and the non-PPCs group. Factors with P ≤ 0.2 and perceived as potentially clinically meaningful, were included in the binary logistic regression model. The receiver operating characteristic (ROC) curve was drawn and the area under the curve (AUC) was calculated.
Results: A total of 123 children (21.7%) developed postoperative pulmonary complications (PPCs). Multivariate logistic regression analysis showed longer duration of one-lung ventilation (OLV), faster respiratory rate during OLV and inexperienced surgeon were found to be independently risk factors of PPCs. Higher PEEP level was protective factors of PPCs (The maximum PEEP was 7 cmH2O). The prediction model was Logit (P) = -4.41 + 0.006 × OLV duration + 0.063 × OLV respiratory rate + 0.569 × inexperienced surgeon (yes = 1) - 0.16 × maximum PEEP value. The ROC curve showed a good accuracy with an area under the curve of 0.682 (95% CI 0.631-0.734), and sensitivity was 76.4%, and specificity was 69.6%.
Conclusion: Longer OLV duration, faster repiratory rate and less surgeon experience are found to be independently risk factors of PPCs. Higher PEEP level is protective factor of PPCs. |
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