摘要
目的 探讨新型冠状病毒(SARS-CoV-2)感染行胸腔镜肺部分切除术患者不同手术时机与术中肺内分流率的相关性.方法 选择2022年12月至2023年5月择期行胸腔镜肺部分切除术患者120例,男65例,女55例,年龄30～75岁,BMI 18.5～25.0 kg/m2,ASA Ⅰ或Ⅱ级.根据感染后不同手术时机将SARS-CoV-2感染手术患者分为三组:感染后5～8周组(B组)、感染后9～12周组(C组)和感染后13～16周组(D组),每组30例.另选择非感染手术患者30例作为对照组(A组).于双肺通气10 min、单肺通气15、30 min时测定桡动脉和混合静脉血血气,计算肺内分流率(Qs/Qt).采用多重线性回归分析探讨SARS-CoV-2感染肺部手术患者不同手术时机与术中肺内分流率的相关性.记录术后7 d内肺部并发症(PPCs)发生情况.结果 与A组比较,B组和C组双肺通气10 min、单肺通气15、30 min PaO2明显降低,Qs/Qt明显升高(P＜0.05);D组单肺通气15、30 min PaO2明显降低,Qs/Qt明显升高(P＜0.05);B组术后7 d内肺部感染和呼吸衰竭发生率明显升高(P＜0.05).与B组比较,D组术后7 d内肺部感染和呼吸衰竭发生率明显降低(P＜0.05).多重线性回归分析显示,感染时间短(β=-0.478,95％CI-3.857～-1.231,P＜0.001)、感染临床分型加重(β=0.274,95％CI 0.368～3.453,P=0.016)和术前存在持续症状(β=-0.240,95％CI-5.986-0.537,P=0.019)与双肺通气10 min时肺内分流率增加相关;感染时间短(β=0.267,95％CI 0.130～3.018,P=0.033)、感染临床分型加重(β=-0.391,95％CI-4.715～-1.323,P=0.001)、术前存在持续症状(β=-0.497,95％CI-10.484～-4.491,P＜0.001)和术前存在呼吸困难(β=-0.246,95％CI-8.596-0.691,P=0.022)与单肺通气15 min时肺内分流率增加相关.结论 SARS-CoV-2感染后5～8、9～12周肺内分流率增加,但在感染后13～16周双肺通气10 min时的肺内分流率逐渐恢复,在此间期手术的患者具有更低的PPCs发生率.感染时间短、感染临床分型加重、术前存在持续症状与肺内分流率增加相关.
Abstract
Objective To investigate the correlation between different operation timing of thoraco-scopic partial pneumonectomy and intraoperative intrapulmonary shunt rate in patients with novel coronavirus(SARS-CoV-2)infection.Methods A total of 120 patients,65 males and 55 females,aged 30-75 years,BMI 18.5-25.0 kg/m2,ASA physical status Ⅰ or Ⅱ,scheduled for elective thoracoscopic partial pneumo-nectomy from December 2022 to May 2023 were selected.The patients with SARS-CoV-2 infection were di-vided into three groups according to different operation timing after infection:5-8 weeks after infection(group B),9-12 weeks after infection(group C),and 13-16 weeks after infection(group D),30 pa-tients in each group.In addition,30 non-infected patients were selected as the control group(group A).Blood gas analysis was performed at 10 minutes of two-lung ventilation(TLV)and 15 and 30 minutes of one-lung ventilation(OLV)to measure radial artery and mixed venous blood gases.Intrapulmonary shunt rate(Qs/Qt)was calculated accordingly.Multiple linear regression analysis was used to investigate the cor-relation between different operation timing and intrapulmonary shunt rate in patients with SARS-CoV-2 infec-tion.The occurrence of postoperative pulmonary complications(PPCs)within 7 days after surgery was re-corded.Results Compared with group A,groups B and C exhibited significant decreases in PaO2 levels and increases in Qs/Qt ratios at 10 minutes of TLV as well as at 15 and 30 minutes of OLV(P＜0.05),group D exhibited significant decreases in PaO2 levels and increases in Qs/Qt ratios at 15 and 30 minutes of OLV(P＜0.05),group B exhibited significant increases in postoperative pulmonary infection rates and the incidence of respiratory failure within 7 days after surgery(P＜0.05).Compared with group B,the inci-dence of pulmonary infection and respiratory failure within 7 days after surgery were significantly reduced in group D(P＜0.05).Multiple linear regression analysis revealed that shorter infection time(β=-0.478,95％CI-3.857 to-1.231,P＜0.001),worsening clinical types of infection(β=0.274,95％CI 0.368 to 3.453,P=0.016),and preoperative persistent symptoms(β=-0.240,95％CI-5.986 to-0.537,P=0.019)were associated with increased intrapulmonary shunt rate at 10 minutes of TLV.Shor-ter infection time(β=0.267,95％CI 0.130 to 3.018,P=0.033),worsening clinical types of infection(β=-0.391,95％CI-4.715 to-1.323,P=0.001),preoperative persistent symptoms(β=-0.497,95％CI-10.484 to-4.491,P＜0.001),and preoperative dyspnea(β=-0.246,95％CI-8.596 to-0.691,P=0.022)were associated with increased intrapulmonary shunt rate at 15 minutes of OLV.Conclusion SARS-CoV-2 infection increases intrapulmonary shunt rate 5-8 and 9-12 weeks after infection,but the intrapulmonary shunt rate gradually recovers at 10 minutes of TLV 13-16 weeks after in-fection,and patients who undergo surgery during this interval have a lower incidence of PPCs.The shorter infection time,the aggravation of clinical classification of infection,and the presence of persistent symptoms before surgery are associated with the increase of intrapulmonary shunt rate.
维普
万方数据