新型冠状病毒2感染后患者肺手术时机与术后肺部并发症的关系：一项前瞻性队列研究。
The relationship between the timing of lung surgery and postoperative pulmonary complications in patients after SARS-CoV-2 infection: a prospective cohort study.
作者信息
Yang Dawei, Li Min, Duan Xianning, Ji Fuhai, Zhang Jianyou
机构信息
Department of Anesthesiology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China.
Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, China.
出版信息
Front Med (Lausanne). 2025 Jul 28;12:1640475. doi: 10.3389/fmed.2025.1640475. eCollection 2025.
BACKGROUND
Patients with a positive test for SARS-CoV-2 prior to elective surgery early in the pandemic have an elevated risk of perioperative mortality and pulmonary complications. Post-SARS-CoV-2 infection, pulmonary sequelae persist beyond the acute stage, necessitating recovery periods spanning months or even longer. Our study aimed to explore the correlation between the timing of thoracoscopic lung surgery and postoperative pulmonary complications (PPCs) in patients with a history of SARS-CoV-2 infection.
METHODS
We conducted a prospective cohort study, enrolling patients scheduled for elective thoracoscopic partial lung resection. Participants were categorized into two groups based on the duration since their SARS-CoV-2 infection: 5-10 weeks and 11-16 weeks. A total of 68 patients were included, with 34 in each group. The information about SARS-CoV-2 infection were collected; IL-6 and TNF- levels at 2 h, 1 d, and 2 d after surgery and the WBC count and CRP level in blood at 1 d and 2 d after surgery were analyzed; and PPCs and length of hospitalization were recorded. A logistic regression model was employed to assess the relationship between the timing of lung surgery and PPCs in patients post SARS-CoV-2 infection.
RESULTS
Compared with the 5-10-week group, in the 11-16-week group, the levels of IL-6 and TNF- at 2 h, 1 d, and 2 d after surgery were significantly lower, the WBC count and CRP levels in blood at 1 d and 2 d after surgery were significantly lower, the numbers of PPCs and lung infections were significantly lower, and the length of hospitalization was significantly shorter. Multivariate logistic regression analysis revealed that the time interval from surgery to SARS-CoV-2 infection, persistent preoperative symptoms, preoperative difficulty breathing and WBC count at 1 d after surgery were independent risk factors for PPCs.
CONCLUSION
Patients infected with SARS-CoV-2 who underwent thoracoscopic lung surgery within 5 to 10 weeks after infection had a higher risk of PPCs than those who had surgery at 11 to 16 weeks post-infection.
CLINICAL TRIAL REGISTRATION
https://clinicaltrials.gov/, ChiCTR2300071539.
背景
在疫情早期择期手术前SARS-CoV-2检测呈阳性的患者围手术期死亡率和肺部并发症风险升高。SARS-CoV-2感染后，肺部后遗症在急性期后仍会持续存在，需要数月甚至更长时间的恢复期。我们的研究旨在探讨有SARS-CoV-2感染史的患者行胸腔镜肺手术的时间与术后肺部并发症（PPCs）之间的相关性。
方法
我们进行了一项前瞻性队列研究，纳入计划行择期胸腔镜部分肺切除术的患者。根据自SARS-CoV-2感染后的时长，将参与者分为两组：5 - 10周组和11 - 16周组。共纳入68例患者，每组34例。收集SARS-CoV-2感染的相关信息；分析术后2小时、1天和2天的白细胞介素-6（IL-6）和肿瘤坏死因子（TNF-）水平以及术后1天和2天血液中的白细胞计数和C反应蛋白（CRP）水平；记录PPCs和住院时长。采用逻辑回归模型评估SARS-CoV-2感染后患者肺手术时间与PPCs之间的关系。
结果
与5 - 10周组相比，11 - 16周组术后2小时、1天和2天的IL-6和TNF-水平显著更低，术后1天和2天血液中的白细胞计数和CRP水平显著更低，PPCs和肺部感染的数量显著更少，住院时长显著更短。多因素逻辑回归分析显示，手术至SARS-CoV-2感染的时间间隔、术前症状持续存在、术前呼吸困难以及术后1天的白细胞计数是PPCs的独立危险因素。
结论
感染SARS-CoV-2后5至10周内行胸腔镜肺手术的患者比感染后11至16周手术的患者发生PPCs的风险更高。
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