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老年患者胸腔镜肺切除术后并发症的影响因素研究

Factors Influencing the Incidence of Complications After Thoracoscopic Pulmonary Resection in Elderly Patients

    摘要
  • 摘要:
    目的 探讨老年患者胸腔镜肺切除术后并发症的影响因素，为高危老年患者术前预康复策略的制订提供科学依据。
    方法 本研究为回顾性研究，选取2019年4月—2023年7月在北京协和医院胸外科行胸腔镜肺切除术的老年患者为研究对象，收集患者的一般临床资料、肺功能(pulmonary function testing，PFT)及心肺运动试验(cardiopul-monary exercise test，CPET)参数等信息，并统计术后并发症事件及发生率，通过单因素分析、Logistic多因素回归分析，探索术后并发症发生的影响因素。
    结果 共纳入符合条件的患者219例，其中有并发症组44例，无并发症组175例。单因素分析结果表明，并发症组的体质量指数(body mass index，BMI)、吸烟者比例、肺叶切除术比例和既往心律失常比例更高，第一秒用力呼气容积(forced expiratory volume in 1 second，FEV1)占预计值的百分比、用力肺活量(forced vital capacity，FVC)占预计值的百分比、呼气流量峰值(peak expiratory flow，PEF)占预计值的百分比、峰值耗氧量(peak oxygen uptake，peak VO2)、静息血氧饱和度(arterial oxygen saturation，SpO2%)较低。多因素Logistic回归分析显示，肺叶切除、既往心律失常病史、FVC%pred下降、peak VO2下降与术后并发症的发生可能有关(OR=6.04，95% CI：2.55~14.33；OR=3.13，95% CI：1.08~9.12；OR=1.04，95% CI：1.01~1.06；OR=1.17，95% CI：1.03~1.32)。
    结论 手术切除方式、既往心律失常病史、FVC%pred、peak VO2与老年患者胸腔镜肺切除术后并发症的发生风险增加显著相关。

     

    Abstract:
    Objective To investigate the influencing factors of postoperative complications following thoracoscopic lung resection in elderly patients and to provide a scientific basis for developing preoperative prehabilitation strategies for high-risk elderly populations.
    Methods This retrospective study enrolled elderly patients who underwent video-assisted thoracoscopic surgery(VATS) lung resection at the Department of Thoracic Surgery, Peking Union Medical College Hospital between April 2019 and July 2023. General clinical data, pulmonary function testing(PFT) parametersincluding forced expiratory volume in 1 second(FEV1%pred), forced vital capacity(FVC%pred), and peak expiratory flow(PEF%pred), cardiopulmonary exercise testing(CPET) parameterspeak oxygen uptake(peak VO2) and resting arterial oxygen saturation(SpO2), etc., and postoperative complications were collected. Univariate analysis and multivariate Logistic regression were performed to identify independent risk factors for postoperative complications.
    Results Among 219 eligible patients, 44 developed postoperative complications(complication group), while 175 did not(non-complication group). Univariate analysis revealed that the complication group had higher body mass index(BMI), smoking rates, lobectomy rates, and prevalence of preexisting arrhythmias, along with lower FEV1%pred, FVC%pred, PEF%pred, peak VO2, and resting SpO2(all P < 0.05). Multivariate Logistic regression identified lobectomy(OR=6.04, 95% CI: 2.55-14.33), history of arrhythmia(OR=3.13, 95% CI: 1.08-9.12), decreased FVC%pred(OR=1.04, 95% CI: 1.01-1.06), and reduced peak VO2(OR=1.17, 95% CI: 1.03-1.32) as independent risk factors for postoperative complications.
    Conclusions Lobectomy, preexisting arrhythmias, decreased FVC%pred, and reduced peak VO2 are significantly associated with an elevated risk of postoperative complications in elderly patients undergoing VATS lung resection. These findings underscore the importance of preoperative risk stratification and tailored prehabilitation strategies to optimize outcomes in this population.

     

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