摘要
目的 探讨老年非小细胞肺癌(NSCLC)患者发生术后肺部并发症(PPC)的影响因素及其短期预后.方法 纳入2022年8月至2023年6月在福建省立医院胸外科行胸腔镜下肺部分切除术的老年NSCLC患者(60～80岁)150例,根据是否发生PPC分为PPC组(发生PPC,35例)和nPPC组(未发生PPC,115例),分析PPC的影响因素,并于术前、出院1周及出院1个月进行中文版莱斯特咳嗽量表(LCQ-MC)、简化咳嗽积分(sCSS)、改良版英国医学研究委员会呼吸困难量表(mMRC)问卷调查,比较两组患者术后相关生活质量指标,探讨其短期预后的差异,组间比较采用独立样本t检验,Log-rank及cox回归等统计学分析.结果 单因素分析显示,体重、性别、吸烟史、肺功能用力肺活量(FVC)、糖尿病史、手术方式与老年NSCLC患者PPC的发生有关(x2=2.013、1.863、4.301、7.056,P＜0.05);多因素分析显示,手术方式和糖尿病史是老年NSCLC患者发生PPC的高危因素[比值比(OR)＞1且P＜0.05].出院1个月,nPPC组患者LCQ-MC生理、心理、社会及总评分显著高于 PPC 组[(5.90±1.04)、(5.83±1.16)、(6.02±0.99)、(17.75±3.17)分比(5.46±0.78)、(5.38±0.96)、(5.62±0.78)、(16.46±2.46)分,t=-2.680、-2.293、-2.470、-2.520,P＜0.05].出院1个月,nPPC组患者sCSS日间咳嗽积分、总咳嗽积分显著低于PPC组[(0.59±0.54)、(1.01±1.01)分 比(0.89±0.40)、(1.51±0.89)分,t=3.461、2.658,P＜0.05].结论 老年NSCLC患者PPC的发生影响其术后短期内生活质量,PPC的影响因素不容忽视,应根据不同影响因素提前采取有效干预措施以降低发生率.
Abstract
Objective To explore the influencing factors and short-term prognosis of postoperative pulmonary complication(PPC)in elderly patients with non-small cell lung cancer(NSCLC).Methods Collect 150 elderly NSCLC patients who underwent thoracoscopic partial resection of the lung in our hospi-tal from August 2022 to June 2023,and divide them into PPC group(35 cases)and nPPC group(115 cases).Analyze the influencing factors of PPC.All selected patients underwent questionnaire sur-veys leicester cough questionnaire in mandarin Chinese version(LCQ-MC),simplified cough symptom score(sCSS),and modified medical research council(mMRC)before surgery,one week after discharge,and one month after discharge.Compare the relevant quality of life indicators between two groups of pa-tients and explore the differences in their short-term prognosis.Inter group comparison was analyzed using independent sample t-test,log rank,and Cox regression.Results The univariate analysis of PPC showed that body weight,gender,smoking history,forced vital capacity(FVC),history of diabetes,and operation mode were related to PPC in elderly NSCLC patients(x2=2.013,1.863,4.301,7.056,P＜0.05).Multivariate analysis showed that the mode of operation and the history of diabetes were the risk factors for PPC[odds ratio(OR)＞1,P＜0.05].One month after discharge,the LCQ-MC physiological,psychologi-cal,social,and overall scores of patients in the nPPC group were significantly higher than those in the PPC group[(5.90±1.04),(5.83±1.16),(6.02±0.99),(17.75±3.17)points vs.(5.46±0.78),(5.38±0.96),(5.62±0.78),(16.46±2.46)points,t=-2.680,-2.293,-2.470,-2.520,P＜0.05].One month after discharge,the sCSS daytime cough score and total cough score of patients in the nPPC group were significantly lower than those in the PPC group[(0.59±0.54),(1.01±1.01)points vs.(0.89±0.40),(1.51±0.89)points,t=3.461,2.658,P＜0.05].Conclusion The occur-rence of PPC in elderly NSCLC patients affects their short-term postoperative quality of life.The influencing factors of PPC cannot be ignored,and effective intervention measures should be taken in advance according to different influencing factors to reduce the incidence rate.
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