Department of Anaesthesiology, HongHui Hospital, Xi'an JiaoTong University, Xi'an, Shaanxi Province, China.
Department of Anaesthesiology, Binzhou Medical College Affiliated Hospital, Binzhou, Shandong Province, China.
J Clin Anesth. 2024 Dec;99:111675. doi: 10.1016/j.jclinane.2024.111675. Epub 2024 Nov 5.
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.
Prospective observational study.
A Chinese tertiary orthopedic hospital.
This observational study included 369 patients with blunt thoracic trauma who underwent surgery for pelvic and upper or lower extremity fractures.
Lung ultrasonography was performed pre- and postoperatively.
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.
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.
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.
Clinical Trial Number: 1900023408. Registered on May 26, 2019.
钝性胸部创伤患者术后发生肺部并发症（PPCs）的风险较高。本研究旨在确定钝性胸部创伤患者行非胸部手术后发生 PPC 的危险因素，并探讨围手术期肺超声评分预测 PPC 发生的效能。
前瞻性观察性研究。
中国一家三级骨科医院。
本观察性研究纳入了 369 例因骨盆和上下肢骨折行手术治疗的钝性胸部创伤患者。
患者术前和术后均进行了肺部超声检查。
对患者进行为期 1 周的随访，以评估 PPC 情况，并将其分为 PPC 组和非 PPC 组。我们使用单因素和多因素逻辑回归分析确定 PPC 的危险因素。使用受试者工作特征（ROC）曲线评估这些危险因素的预测价值。
PPC 的发生率为 36.58%。两组患者的损伤严重程度评分、美国麻醉医师协会（ASA）分级、慢性阻塞性肺疾病、血胸、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、加泰罗尼亚外科患者呼吸风险评估（ARISCAT）评分存在显著差异（P<0.05）。PPC 的独立危险因素包括 ASA 分级Ⅲ级、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，截断值：10）、术前血红蛋白水平（AUC：0.627，截断值：97）、术中输液量（AUC：0.701，截断值：886.51mL/h）和 ARISCAT 评分（AUC：0.718，截断值：33）能够有效预测术后结果。
术后肺部超声评分可有效预测钝性胸部创伤患者非胸部手术后的肺部并发症。ASA 分级Ⅲ级、术前贫血、术中液体输入过多、较高的 ARISCAT 和术后肺部超声评分是与 PPC 相关的显著危险因素。
临床试验编号：1900023408。注册于 2019 年 5 月 26 日。
