胸腔镜手术术中低氧血症的多因素回顾性研究

发布时间：2018-03-19 08:19

  本文选题：Logistic分析　切入点：胸腔镜手术　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:低氧血症是胸腔镜术中单肺通气时所发生的严重并发症,而大多数以低氧血症为研究中心的相关研究则以单因素分析为主,多因素分析相比较单因素独立分析而言,考虑了每个因素之间的内在关联和相互作用,结果更为可靠。本研究通过收取大连医科大学附属第一医院病历资料利用回顾性研究的方法,运用logistic逐步回归法对影响胸腔镜术中低氧血症发生的相关因素进行分析,探讨胸腔镜术中单肺通气时与低氧血症有关的因素,为预测术前低氧血症和防治术中低氧血症提供可靠参考从而提高胸腔镜手术和麻醉的安全性。方法:本研究采用回顾性分析的方法对收取的大连医科大学附属第一医院2016年8月至2016年12月期间,接受胸腔镜手术患者的临床病历资料551例进行回顾性研究,通过参考相关资料文献收集患者的临床病历资料,收集患者的一般资料情况(性别、年龄),既往史(是否规律服用血管活性药物,肺部疾病病史),术前情况(红细胞水平、白蛋白水平、肺功能、肾功能、ASA分级、心脏彩超),以及术中情况(手术种类、手术体位、双腔支气管导管类型、麻醉方式、入室平均动脉压、开始单肺通气时距手术开始时间)。对影响胸腔镜术中低氧血症发生的相关因素进行单因素分析,进而筛选出P0.1的变量进行多因素logistic逐步回归分析,探讨胸腔镜术中单肺通气时与低氧血症相关的因素,为预测术前低氧血症和防治术中低氧血症提供可靠参考从而提高胸腔镜手术和麻醉的安全性。结果:在本次研究共纳入的551例病例中发生低氧血症的发生率为8.9%(共49例)。在单因素分析中,有6个因素与胸腔镜手术中单肺通气中发生低氧血症相关,分别是:ASA(P=0.002,r=0.129),开始单肺通气时距手术开始时间(P=0.071,r=-0.077),手术种类(P=0.032,r=0.091),肺功能(P=0.034,r=-0.090),心脏彩超(P=0.024,r=0.096),术中是否使用血管活性药物(P=0.037,r=0.089)。通过多因素logistic逐步回归分析共有5个具有统计学意义(P0.05)的因素被选入回归方程。其中危险因素有3个,分别是心脏彩超(0R=2.405,P=0.018),ASA分级(OR=2.378,P=0.008),手术种类(0R=1.389,P=0.021),保护因素有 2 个,分别是肺功能(OR=O.502,P=0.047),开始单肺通气时距手术开始时间(OR=0.594,P=0.024)。结论:1.ASA分级,手术种类,心脏彩超为胸腔镜术中发生低氧血症发生的危险因素。随着ASA分级的升高,手术种类的变化,心脏彩超的异常,胸腔镜术中低氧血症的发生率将升高。2.肺功能和开始单肺通气时距手术开始时间,为胸腔镜术中低氧血症发生的保护因素。随着肺功能的异常和开始单肺通气时距手术开始时间的增加,胸腔镜术中低氧血症的发生率将下降。
[Abstract]:Objective: hypoxemia is a serious complication of thoracoscopy in one lung ventilation occurred, and most of the Research Center for study of hypoxemia in univariate analysis, multivariate analysis comparing independent single factor analysis, correlation and interaction between each factor is taken into account, the result is more reliable this study. Through a retrospective study method using the medical records of the First Affiliated Hospital of Dalian Medical University, the use of logistic related factors on the impact of hypoxia in thoracoscopy in the regression analysis, to explore the factors associated with hypoxemia for single lung ventilation in thoracoscopy, provide a reliable reference for preoperative prediction of hypoxic hypoxia prevention and treatment of postoperative hypoxemia and in thoracoscopic surgery and to improve the safety of anesthesia. Methods: This study used a retrospective analysis of the medical charge in Dalian Department of the First Affiliated Hospital from August 2016 to December 2016 period, patients received thoracoscopic surgery the clinical data of 551 cases were reviewed by clinical data refer to the relevant literature were collected, the general data were collected (gender, age), history (whether the regular use of vasoactive drugs, lung disease), preoperative (red blood cell levels, albumin level, pulmonary function, renal function, ASA classification, cardiac ultrasound), and intraoperative (type of surgery, surgical position, double lumen tube type, anesthesia, a mean arterial pressure during one lung ventilation, beginning from the operation start time of single factor). Analysis of the influencing factors of hypoxia in thoracoscopy of hyponatremia, and then screened P0.1 variables were analyzed by logistic regression analysis of single lung ventilation in thoracoscopy with low The factors related to hypoxemia, to provide reliable reference of preoperative prediction and prevention and treatment of postoperative hypoxemia hypoxia in thoracoscopic surgery and to improve the safety of anesthesia. Results: hypoxemia occurred in 551 cases in this study included the incidence rate was 8.9% (49 cases). In univariate analysis, there are 6 factors and one lung ventilation in thoracoscopic surgery in hypoxemia, respectively is: ASA (P=0.002, r=0.129), start one lung ventilation from the operation start time (P=0.071, r=-0.077), operation type (P=0.032, r=0.091), pulmonary function (P=0.034, r=-0.090), echocardiography (P=0.024, r=0.096), whether the use of intraoperative vasoactive drugs (P=0.037, r=0.089). By multivariate stepwise logistic regression analysis, there were 5 statistically significant factors (P0.05) were selected in the regression equation. The risk factors were 3, echocardiography (0R=2.405, P=0.018), ASA classification (OR=2.378, P=0.008), operation type (0R=1.389, P=0.021), there are 2 protective factors were pulmonary function (OR=O.502, P=0.047), start one lung ventilation from the operation start time (OR=0.594, P=0.024). Conclusion: 1.ASA classification, type of surgery, heart disease are the risk factors of hypoxemia occurred in thoracoscopy. With the increase of ASA grading, change the type of surgery, abnormal echocardiography, thoracoscopy in the incidence of hypoxemia will increase.2. pulmonary function and start one lung ventilation from the operation start time, protective factors for thoracic surgery hypoxemia. With the exception and began to increase from the operation start time of single lung ventilation pulmonary function, the incidence of thoracoscopy in hypoxemia will decrease.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614
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本文编号：1633417