Aisiaiti Abudushalamu, Ajiaikebaier Aiwuzaili, Maimaitiming Aini, Geng Qiang, He Bichen, Sun Jinhui, Zhang Bing
Center for Anesthesia and Perioperative Medicine, Xinjiang Medical University Affiliated Tumor Hospital, Urumqi, 830011, People's Republic of China.
Ther Clin Risk Manag. 2025 Apr 23;21:501-509. doi: 10.2147/TCRM.S519646. eCollection 2025.
To investigate the association of diaphragmatic mobility and thickening fraction with postoperative pulmonary complications (PPCs) in patients undergoing thoracic surgery and evaluate their values in predicting PPCs.
One hundred and nine consecutive patients undergoing thoracic surgery were prospectively enrolled. All patients underwent ultrasound measurements to obtain diaphragmatic mobility and thickening fraction. PPCs were systematically monitored and recorded from postoperative day 1 to 7. The binary logistic regression model was used to perform multivariate analysis, and the receiver operating characteristic (ROC) curve was used to evaluate predictive values.
PPCs occurred in 46 patients (42.2%). Multivariate analysis identified age, smoking, surgical sites, and mean diaphragmatic mobility and thickening fraction of operated side and nonoperated side as independent risk factors for PPCs. ROC curves revealed that the AUC of mean diaphragmatic mobility and thickening fraction for predicting PPCs in patients undergoing thoracic surgery was 0.722 [standard error (): 0.050, 95% confidence interval (): 0.6230.821, <0.001] and 0.757 (: 0.050, 95% : 0.6590.855, <0.001), respectively. The predictive model integrating age, smoking and surgical sites yielded an AUC of 0.810 (: 0.041, 95% : 0.7280.891, <0.001), while the predictive model integrating age, smoking, surgical sites and mean diaphragmatic mobility or thickening fraction yielded an AUC of 0.849 (: 0.037, 95% : 0.7770.922, <0.001) and 0.881 (: 0.033, 95% : 0.815~0.946, <0.001), respectively.
Both diaphragmatic mobility and thickening fraction showed independent associations with PPCs following thoracic surgery, demonstrating moderate predictive values. The predictive models integrating age, smoking, surgical sites and diaphragmatic mobility or thickening fraction yielded high predictive values, suggesting significant clinical utility for risk stratification. Diaphragmatic mobility and thickening fraction offer a bedside, noninvasive, and cost-effective alternative for perioperative PPC prediction, particularly in resource-limited settings.
探讨胸外科手术患者膈肌活动度和增厚率与术后肺部并发症（PPCs）的相关性，并评估其在预测PPCs方面的价值。
前瞻性纳入109例连续接受胸外科手术的患者。所有患者均接受超声测量以获取膈肌活动度和增厚率。从术后第1天至第7天对PPCs进行系统监测和记录。采用二元逻辑回归模型进行多因素分析，并使用受试者工作特征（ROC）曲线评估预测价值。
46例患者（42.2%）发生了PPCs。多因素分析确定年龄、吸烟、手术部位以及手术侧和非手术侧的平均膈肌活动度和增厚率为PPCs的独立危险因素。ROC曲线显示，胸外科手术患者中，平均膈肌活动度和增厚率预测PPCs的曲线下面积（AUC）分别为0.722[标准误（SE）：0.050，95%置信区间（CI）：0.6230.821，P<0.001]和0.757（SE：0.050，95%CI：0.6590.855，P<0.001）。整合年龄、吸烟和手术部位的预测模型的AUC为0.810（SE：0.041，95%CI：0.7280.891，P<0.001），而整合年龄、吸烟、手术部位和平均膈肌活动度或增厚率的预测模型的AUC分别为0.849（SE：0.037，95%CI：0.7770.922，P<0.001）和0.881（SE：0.033，95%CI：0.815~0.946，P<0.001）。
膈肌活动度和增厚率均与胸外科手术后的PPCs存在独立相关性，显示出中等预测价值。整合年龄、吸烟、手术部位和膈肌活动度或增厚率的预测模型具有较高的预测价值，表明其在风险分层方面具有显著的临床实用性。膈肌活动度和增厚率为围手术期PPCs预测提供了一种床边、无创且经济有效的替代方法，尤其在资源有限的环境中。
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