IF 2.1 3区 医学 Q3 RESPIRATORY SYSTEM
Journal of thoracic disease Pub Date : 2025-02-28 Epub Date: 2025-02-21 DOI:10.21037/jtd-24-1454
Ruixue Yuan, Wanling Xiong, Wei Ran, Ning Liang, Jie Tang, Lin Cheng, Xia Yin, Jin Gao
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引用次数: 0

摘要

背景:视频辅助胸腔镜手术(VATS)经常导致大量术后肺部并发症(PPC)。膈肌是参与呼吸的主要肌肉。膈肌超声越来越多地被用作评估膈肌收缩功能的无创性便携工具。膈肌游离差(DED)为临床结果提供了有价值的预测指标。这项前瞻性观察研究旨在评估 DED 对接受 VATS 患者的 PPCs 的预测可行性:方法:2023 年 3 月至 8 月期间,共有 151 名接受 VATS 手术的患者被纳入研究。每位患者都在麻醉前和拔管后一小时内接受了膈肌超声检查。在这些检查中,记录了安静呼吸(QB)和深呼吸(DB)时的膈肌偏移(DE)。在这两个时间点计算出 DED 和横膈膜偏移分数 (DEF)。测量的主要结果是术后七天内主要肺部并发症的发生率,次要结果包括膈肌功能障碍发生率、住院时间、氧合状态以及术后第一天和第二天的疼痛评分:对 151 名患者的数据进行了分析,结果显示有 32 名患者(21%)出现了 PPCs。出现 PPCs 的患者在 DB 期间的术后膈肌偏移量明显较低(2.27±0.59 vs. 3.31±0.99,Pvs. 1.94±0.91,Pvs. 0.44±0.12,PConclusions):VATS术后,术后较低的DED可作为额外的标记物。这有助于预测肺部并发症的风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Diaphragm excursion difference as an adjunct predictor marker of postoperative pulmonary complications in video-assisted thoracoscopic surgery: a prospective, observational study.

Background: Video-assisted thoracoscopic surgery (VATS) often leads to a significant number of postoperative pulmonary complications (PPCs). The diaphragm is the primary muscle involved in respiration. Diaphragm ultrasound is increasingly used as a noninvasive and portable tool for evaluating diaphragmatic contractile function. The diaphragm excursion difference (DED) provides a valuable predictive measure for clinical outcomes. This prospective, observational study aimed to evaluate the predictive feasibility of DED in relation to PPCs in patients undergoing VATS.

Methods: Between March and August 2023, a total of 151 patients undergoing VATS were enrolled in the study. Each patient underwent diaphragm ultrasound examinations both before anesthesia and within one hour after extubation. During these examinations, diaphragm excursion (DE) was recorded during quiet breathing (QB) and deep breathing (DB). The DED and diaphragm excursion fraction (DEF) were calculated at these two time points. The primary outcome measured was the incidence of major pulmonary complications occurring within seven days after surgery, while secondary outcomes included the rate of diaphragm dysfunction, duration of hospitalization, oxygenation status, and pain scores on the first and second postoperative days.

Results: Data from 151 patients were analyzed, revealing that 32 patients (21%) developed PPCs. Patients who developed PPCs exhibited a significantly lower postoperative diaphragm excursion during DB (2.27±0.59 vs. 3.31±0.99, P<0.001). They also showed a lower postoperative DED (0.94±0.44 vs. 1.94±0.91, P<0.001) and a higher DEF (0.59±0.13 vs. 0.44±0.12, P<0.001) compared to those without PPCs. In receiver operating characteristic curve analysis, the postoperative DED demonstrated a high sensitivity of 90.6% and a lower specificity of 64.7% for predicting PPCs, with an area under the curve (AUC) of 0.860 and a 95% confidence interval (CI) ranging from 0.788 to 0.926.

Conclusions: After VATS, lower postoperative DED may serve as an additional marker. This can help predict the risk of pulmonary complications.

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来源期刊
Journal of thoracic disease
Journal of thoracic disease RESPIRATORY SYSTEM-
CiteScore
4.60
自引率
4.00%
发文量
254
期刊介绍: The Journal of Thoracic Disease (JTD, J Thorac Dis, pISSN: 2072-1439; eISSN: 2077-6624) was founded in Dec 2009, and indexed in PubMed in Dec 2011 and Science Citation Index SCI in Feb 2013. It is published quarterly (Dec 2009- Dec 2011), bimonthly (Jan 2012 - Dec 2013), monthly (Jan. 2014-) and openly distributed worldwide. JTD received its impact factor of 2.365 for the year 2016. JTD publishes manuscripts that describe new findings and provide current, practical information on the diagnosis and treatment of conditions related to thoracic disease. All the submission and reviewing are conducted electronically so that rapid review is assured.
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