目的 评估胸腔镜肺部手术中呼气末正压(positive end-expiratory pressure,PEEP)水平与术后肺部并发症(postoperative pulmonary complications,PPCs)的相关性.方法 回顾性分析四川大学华西医院2022年1月-2023年6月行择期胸腔镜肺部手术患者的临床资料.根据术中PEEP水平将患者分为2组:PEEP 5 cm H2O组和PEEP 10 cm H2O组.采用最邻近匹配法,按照1∶1比例进行配对,设置卡钳值为0.02,比较匹配后两组患者PPCs发生率.结果 共筛选538例患者,倾向性评分匹配后,共匹配229对(458例)患者,平均年龄53.9岁,女性占69.4％(318/458).术后共118例(25.8％)患者住院期间发生PPCs,其中PEEP 5 cm H2O组60例(26.2％),PEEP 10 cm H2O 组 58 例(25.3％),两组差异无统计学意义[OR=0.997,95％CI(0.495,1.926),P=0.915].多因素logistic回归分析显示,PEEP不是PPCs的独立危险因素[OR=0.920,95％CI(0.587,1.441),P=0.715].结论 胸腔镜肺手术患者术中PEEP(5 cm H2O或10 cm H2O)与术后住院期间PPCs发生风险无显著相关性,尚需前瞻性、大样本随机对照研究进一步验证.
The association of intraoperative positive end-expiratory pressure with pulmonary complications after thoracoscopic lung surgery:A propensity score-matching study
Objective To evaluate the correlation between positive end-expiratory pressure(PEEP)level and postoperative pulmonary complications(PPCs)in patients undergoing thoracoscopic lung surgery.Methods The clinical data of patients who underwent elective thoracoscopic lung surgery at West China Hospital of Sichuan University from January 2022 to June 2023 were retrospectively analyzed.Patients were divided into 2 groups according to intraoperative PEEP levels:a PEEP 5 cm H2O group and a PEEP 10 cm H2O group.The incidence of PPCs in the two groups after matching was compared using a nearest neighbor matching method with a ratio of 1∶1,setting the clamp value as 0.02.Results A total of 538 patients were screened,and after propensity score-matching,a total of 229 pairs(458 patients)were matched,with an average age of 53.9 years and 69.4％(318/458)females.A total of 118(25.8％)patients had PPCs during hospitalization after surgery,including 60(26.2％)patients in the PEEP 5 cm H2O group and 58(25.3％)patients in the PEEP 10 cm H2O group,with no statistically significant difference between the two groups[OR=0.997,95％CI(0.495,1.926),P=0.915].Multivariate logistic regression analysis showed that PEEP was not an independent risk factor for PPCs[OR=0.920,95％CI(0.587,1.441),P=0.715].Conclusion For patients undergoing thoracoscopic lung surgery,intraoperative PEEP(5 cm H2O or 10 cm H2O)is not associated with the risk of PPCs during hospitalization after surgery,which needs to be further verified by prospective,large-sample randomized controlled studies.
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