老年胸部手术患者术前呼出气一氧化氮 与术后肺部并发症的关系

Relationship between concentration of preoperative fractional exhaled nitric oxide and postoperative pulmonary complications in elderly patients undergoing thoracic surgery

摘要:

目的 探讨老年胸部手术患者术前呼出气一氧化氮（FeNO）与术后肺部并发症（PPCs）的关 系。方法 选取2017 年6 月—2019 年6 月锦州医科大学附属第一医院收治的92 例老年胸部手术患者作为 研究对象。根据是否发生PPCs，分为PPCs 组16 例与非PPCs 组76 例。详细统计患者临床体检和手术资料， 并采用纳库伦呼气分析仪测定术前10 min FeNO。结果 PPCs 组年龄高于非PPCs 组（P <0.05），有吸烟史、 COPD 患者占比高于非PPCs 组（P <0.05），腔镜手术患者占比低于非PPCs 组（P <0.05）。PPCs 组与非PPCs 组术前10 min FeNO 分布情况比较，差异有统计学意义（P <0.05）。将年龄、吸烟史、COPD、是否腔镜手 术及术前10 min FeNO 纳入二元Logistic 回归分析，结果显示腔镜手术[Ol ^ R=12.18（95 CI ：1.28，116.33）]、 年龄[Ol ^ R=0.88（95 CI ：0.81，0.96）]、COPD[Ol ^ R=758.20（95 CI ：11.04，52 086.77）] 及术前10 min FeNO[Ol ^ R=1.34（95 CI ：1.13，1.59）] 是老年胸部手术患者PPCs 的影响因素。根据术前10 min FeNO 绘制 ROC 曲线图，曲线下面积为0.821，此时FeNO 截断值为27.5 ppb，约登指数为0.583，敏感性为68.8%，特异 性为89.5%。结论 术前10 min FeNO 过高与老年胸部手术患者PPCs 发生风险增加有关。

Abstract:

Objective To investigate the relationship between concentration of preoperative fractional exhaled nitric oxide (FeNO) and postoperative pulmonary complications (PPCs) in elderly patients undergoing thoracic surgery. Methods Ninety-two elderly patients who underwent thoracic surgery in our hospital were selected as the study objects from June 2017 to June 2019. According to whether PPCs occurred, they were divided into PPCs group (n = 16) and non PPCs group (n = 76). Baseline data and operation related indexes of the two groups were compared. FeNO value of the two groups was measured 10 minutes before operation by naculon breath analyzer. Results The age of PPCs group was higher than that of non PPCs group (P < 0.05); the proportion of patients with smoking history and COPD history was higher than that of non PPCs group (P < 0.05); the proportion of patients with endoscopic surgery was lower than that of non PPCs group, the difference between the groups was statistically significant (P < 0.05). The difference of FeNO distribution between PPCs and non PPCs was statistically significant (P < 0.05).Age, smoking history, COPD history, endoscopic surgery or not and FeNO value in 10 minutes before operation were included in binary logistic regression analysis. The results showed that endoscopic surgery [Ol ^ R=12.18 (95% CI: 1.28, 116.33)], age [Ol ^ R=0.88 (95% CI: 0.81, 0.96)], COPD history [Ol ^ R=758.20 (95% CI: 11.04, 52086.77)] and FeNO value in 10 minutes before operation [Ol ^ R=1.34 (95% CI: 1.13, 1.59)] were the influencing factors of PPCs in elderly patients with thoracic surgery. ROC curve was drawn according to the FeNO value 10 minutes before operation. The area under curve (AUC) was 0.821, and the cut-off value of FeNO was 27.5 ppb. At this time, the Jordan index was 0.583, the sensitivity was 68.8%, and the specificity was 89.5%. Conclusion The high FeNO value 10 minutes before operation was related to the increased risk of PPCs in elderly patients undergoing thoracic surgery.