中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

肺癌患者肺叶切除术术后住院时间延长风险因素分析

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目的 回顾性分析影响肺癌患者肺叶切除术术后住院时间延长的因素。 方法 分析 2012 年 5 月至 2016 年 6 月新乡医学院第一附属医院共 771 例行肺叶切除术原发性肺癌患者的临床资料。根据术后住院时间是否延长分为正常恢复组(551 例,男 317 例、女 234 例, 中位年龄 59 岁,术后住院时间<8.0 d)和术后住院时间延长组(220 例,男 148 例、女 72 例,中位年龄 60 岁,术后住院时间≥8.0 d)。超过第 75% 分位术后住院时间(8.0 d)视为术后住院时间延长。采用多因素 Logistic 回归分析法分析术后住院时间延长独立风险因素。 结果 单因素分析显示男性,心律失常和传导阻滞,FVC% 值偏小,一侧全肺切除术,手术持续时间、麻醉持续时间长,失血量、淋巴结清扫数量为术后住院时间延长的风险因素,且差异有统计学意义(P<0.05)。多因素 Logistic 回归分析发现,年龄≥75 岁[OR=4.1,95%CI(1.7,10.0)]、一侧全肺切除[OR=2.6,95%CI(1.5,4.5)]、FVC%<89.05%[OR=1.5,95%CI(1.0,2.2)]、清扫淋巴结数目≥13.5 个[OR=1.8, 95%CI(1.3,2.6)]以及心律失常[OR=2.9, 95%CI(1.4,6.3)]是术后住院时间延长的独立因素风险。 结论 肺叶切除术患者存在住院时长不同的现象。年龄、手术类型、FVC%、清扫淋巴结数目、心律失常、手术持续时间等因素可影响术后住院时间。明确患者术后住院时间延长风险因素,并细致评估和有效管控相关因素可使患者受益。

Objective To retrospectively analyzed risk factors associated with prolonged length of postoperative hospital stay (LOS) after lobectomy for lung cancer patients. Methods The clinical records of 771 lung cancer patients undergoing lobectomy between May 2012 and June 2016, were retrospectively analyzed. According to different LOS, 771 patients were divided into two groups. In the normal LOS group, there were 551 patients including 234 females and 317 males with a median age of 59 years, whose LOS was shorter than 8.0 days. In the prolonged length of postoperative hospital stay group (PLOS), there were 220 patients including 72 females and 148 males with a median age of 60 years, whoes LOS was longer than 8.0 days. PLOS was defined as longer 75th percentile of LOS. Then, we analyzed the independent risk factors of PLOS by multivariate logistic regression analysis. Results Univariate analysis showed that risk facorts for PLOS included males, arrhythmias and conduction block, smaller FVC%, pneumonectomy, operation and anesthesia duration, intraoperation blood loss and number of lymph node cleaning in the operation, and there was statistically significant (P<0.05). Multivariate Logistic regression analysis showed that the age ≥75 (OR=4.1, 95%CI 1.7 to 10.0), pneumonectomy (OR=2.6, 95%CI 2.6 to 1.5), FVC% < 89.05% ( OR=1.5, 95%CI 1.5 to 1.0), numbers of lymph node dissection≥ 13.5 (OR=1.8, 95%CI 1.8 to1.3), arrhythmia (OR=2.9, 95%CI 2.9 to 1.4) was independent risk factors of PLOS. Conclusion There are different in hospital stay for lung cancer patients undergoing lobectomy. LOS is influenced by age, surgical type, FVC%, numbers of lymph node dissection and arrhythmia. Careful assessment and appropriate management of risk factors are helpful to improve postoperativ recovery after lobectomy for lung cancer patients.

关键词: 住院时间延长; 肺叶切除术; 肺癌

Key words: Prolonged length of stay; lobectomy; lung cancer

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