肺部超声评分能否预测胸部钝伤患者非胸部手术后的肺部并发症？单中心观察研究

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2024-11-05 DOI:10.1016/j.jclinane.2024.111675

Jianhong Hao , Peng Pang , Xiaobing Liu , Wen Chi , Zhenguo Luo , Wenbo Cai , Li Zhang

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引用次数: 0

摘要

研究目的胸部钝挫伤患者术后发生肺部并发症（PPCs）的风险很高。本研究旨在确定钝性胸部创伤患者非胸部手术后发生 PPCs 的风险因素，并探讨围手术期肺超声评分对预测 PPC 发生的有效性。干预措施术前和术后均进行肺部超声检查。我们使用单变量和多变量逻辑回归分析确定了 PPC 的风险因素。主要结果PPCs发生率为36.58%。两组患者在损伤严重程度评分、美国麻醉医师协会（ASA）分类、慢性阻塞性肺病、胸水、术前低氧血症、肺部超声评分、术前血红蛋白水平、术中输液量和加泰罗尼亚地区手术患者呼吸风险评估（ARISCAT）评分方面存在明显差异（P < 0.05）。PPCs 的独立危险因素包括 ASA 分级 III、术后肺部超声评分较高、术前贫血、术中输液量较高和 ARISCAT 评分较高。ROC 曲线分析显示，术后肺部超声评分（曲线下面积 [AUC]：0.810，临界值：10）、术前血红蛋白水平（AUC：0.627，临界值：97）、术中输液量（AUC：0.701，临界值：886.51 mL/h）和 ARISCAT 评分（AUC：0.718，临界值：33）可有效预测术后结果。ASA分级III、术前贫血、术中输液过多、ARISCAT和术后肺部超声评分较高是与PPCs相关的重要风险因素：临床试验编号：1900023408。注册时间：2019年5月26日。

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Can the lung ultrasound score predict pulmonary complications after non-thoracic surgery in patients with blunt thoracic trauma: A single-center observational study

Study objective

Patients with blunt thoracic trauma have a high risk of developing postoperative pulmonary complications (PPCs). In this study, we aimed to identify the risk factors for PPCs after non-thoracic surgery in patients with blunt thoracic trauma and investigate the efficacy of perioperative lung ultrasound scores in predicting PPC occurrence.

Design

Prospective observational study.

Setting

A Chinese tertiary orthopedic hospital.

Participants

This observational study included 369 patients with blunt thoracic trauma who underwent surgery for pelvic and upper or lower extremity fractures.

Interventions

Lung ultrasonography was performed pre- and postoperatively.

Measurements

Patients were followed up for 1 week to assess PPCs and assigned to the PPC or non-PPC groups. We identified risk factors for PPCs using univariate and multivariate logistic regression analyses. The predictive value of these risk factors was evaluated using receiver operating characteristic (ROC) curves.

Main results

PPCs incidence was 36.58 %. The two groups differed significantly in Injury Severity Scores, American Society of Anesthesiologists (ASA) classification, chronic obstructive pulmonary disease, hydrothorax, preoperative hypoxemia, lung ultrasound score, preoperative hemoglobin level, intraoperative infusion volume, and Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) scores (P < 0.05). Independent risk factors for PPCs included ASA classification III, higher postoperative lung ultrasound scores, preoperative anemia, higher intraoperative infusion volume, and higher ARISCAT scores. ROC curve analysis revealed that postoperative lung ultrasound score (area under the curve [AUC]: 0.810, cutoff: 10), preoperative hemoglobin level (AUC: 0.627, cutoff: 97), intraoperative infusion volume (AUC: 0.701, cutoff: 886.51 mL/h) and ARISCAT score (AUC: 0.718, cutoff: 33) predicted postoperative outcomes effectively.

Conclusions

Postoperative lung ultrasound scores reliably predicted pulmonary complications after non-thoracic surgery in patients with blunt thoracic trauma. ASA classification III, preoperative anemia, excessive intraoperative fluid infusion, higher ARISCAT, and postoperative lung ultrasound scores were significant risk factors associated with PPCs.

Trial registration: Clinical Trial Number: 1900023408. Registered on May 26, 2019.

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.