实用医学杂志2024，Vol.40Issue(2)：207-212,6.DOI:10.3969/j.issn.1006-5725.2024.02.014
床旁膈肌超声在预测胸腔镜肺叶切除术后肺部并发症中的应用价值
Predictive value of bedside diaphragmatic ultrasound for pulmonary complications after thoracoscopic lobectomy
摘要
Abstract
Objective To assess the predictive value of bedside diaphragmatic ultrasound in predicting pulmonary complications(PPCs)after thoracoscopic lobectomy.Methods The patients who had undergone elective thoracoscopic lobectomy in Henan Provincial People's Hospital were collected.General information and perioperative indicators were recorded.Diaphragmatic motility was detected by bedside ultrasound preoperatively and on postopera-tive days 1,3,and 5.The patients were divided into two groups(PPCs group and non-PPCs group).Statistically different parameters in univariate analysis were included in multivariate logistic regression analysis to screen inde-pendent influencing factors of PPCs.Receiver operating curve(ROC)was drawn,and the performance of diaphragm ultrasound for predicting PPCs was evaluated by the area under the curve(AUC).Results 949 patients were included in this study.PPCs occurred in 537 patients(57.5% ).Univariate analysis showed that as compared with the non-PPCs group,the proportion of diabetic patients and postoperative VAS score in the PPCs group increased,time to chest tube removal and one-lung ventilation,and postoperative hospital stay were longer.PPCs group had a lower DE value on the operative side and healthy side on postoperative days 1 and 3 and on the operative side alone on day 5(P<0.05).Multivariate logistic regression analysis showed that prolonged one-lung ventilation time,diabetes mellitus,DE values on the operative side and unoperative side on postoperative days 1 and 3,and decreased DE value on the operative side on day 5 were independent risk factors for PPCs.The ROC curve shows that the efficacy of DE for pre-dicting PPCs on the operative and healthy sides on postoperative days 1 and 3 was relatively high(AUC of 0.797,0.821,0.933,and 0.929;respectively).The efficacy of DE for predicting PPCs on the operative side was poor on postoperative day 5(AUC of 0.703 and 0.512,respectively).Conclusions A decrease in postoperative DE,prolonged one-lung ventilation time,and diabetes are independent risk factors for PPCs after thoracoscopic lobectomy.Bedside ultrasound evaluation of DE has a higher value in predicting PPCs three days after surgery.关键词
膈肌超声/肺叶切除术/术后肺部并发症Key words
ultrasonography of diaphragm/lobectomy/postoperative pulmonary分类
医药卫生引用本文复制引用
郭高锋,阮孝国,王洋洋,张加强..床旁膈肌超声在预测胸腔镜肺叶切除术后肺部并发症中的应用价值[J].实用医学杂志,2024,40(2):207-212,6.基金项目
河南省中青年卫生健康科技创新领军人才培养项目(编号:YXKC2020001) （编号:YXKC2020001）
