摘要
目的 筛选恶性肿瘤切除患儿术后肺部并发症(PPCs)的危险因素.方法 回顾性收集2019年8月至2023年7月在浙江大学医学院附属儿童医院接受开腹腹部恶性肿瘤切除术患儿的病历资料,住院时间≥48 h.根据术后7 d内是否发生PPCs分为PPCs组和非PPCs组(non-PPCs组).将差异性检验中P＜0.05的变量纳入二元logistic回归分析,筛选PPCs的危险因素.结果 最终纳入605例腹部恶性肿瘤切除术患儿,其中391例患儿发生PPCs,发生率为64.6％.二元logistic回归结果显示,体质量(P=0.001)、ASA分级(P＜0.001)、术前低白蛋白血症(P=0.013)、术前化疗(P=0.003)、肿瘤压迫/包绕腹部大血管(P=0.002)、麻醉时间(P＜0.001)、术中入量(ml·kg-1·h-1,P＜0.001)、术中使用降压药(P=0.047)、合并经腹纵隔肿瘤切除术(P＜0.001)是恶性肿瘤切除术患儿PPCs的危险因素,年龄(P＜0.001)是PPCs的保护因素.结论 体质量、ASA分级、术前化疗、术前低白蛋白血症、肿瘤压迫/包绕腹部大血管、麻醉时间、术中入量、术中使用降压药和合并经腹纵隔肿瘤切除术是开腹恶性肿瘤切除术患儿PPCs的危险因素,年龄是PPCs的保护因素.
Abstract
Objective To identify the risk factors for postoperative pulmonary complications(PPCs)in pediatric patients undergoing malignant tumor resection.Methods Medical records of pediatric patients who underwent open abdominal malignant tumor resection at Children's Hospital affiliated to Zhe-jiang University School of Medicine from August 2019 to July 2023,with length of hospital stay ≥ 48 h,were retrospectively collected.Patients were divided into PPC group and non-PPC group based on the occur-rence of PPCs within 7 days postoperatively.Variables with P＜0.05 in the univariate analysis were included in the binary logistic regression analysis to identify the risk factors for PPCs.Results A total of 605 pediat-ric patients who underwent abdominal malignant tumor resection were finally included,among which 391 children developed PPCs,with an incidence of 64.6％.Binary logistic regression analysis showed that body weight(P=0.001),American Society of Anesthesiologists Physical Status classification(P＜0.001),pre-operative hypoalbuminemia(P=0.013),preoperative chemotherapy(P=0.003),tumor compression/en-casement of major abdominal vessels(P=0.002),anesthesia duration(P＜0.001),intraoperative fluid in-take(ml·kg-1·h-1,P＜0.001),intraoperative use of hypotensive agents(P=0.047),and concurrent resection of mediastinal tumors via abdominal approach(P＜0.001)were risk factors for PPCs in children undergoing malignant tumor resection.Age(P＜0.001)was identified as a protective factor for PPCs.Con-clusions Body weight,American Society of Anesthesiologists Physical Status classification,preoperative chemotherapy,preoperative hypoalbuminemia,tumor compression/encasement of major abdominal vessels,anesthesia duration,intraoperative fluid intake,intraoperative use of hypotensive agents,and concurrent re-section of mediastinal tumors via abdominal approach are risk factors for PPCs in pediatric patients undergo-ing open abdominal malignant tumor resection,whereas age is a protective factor for PPCs.
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