关键词: 支气管镜, 手术后并发症, 危险因素

Abstract:

Objective： To investigate the early complication rate and identify patient-related indepen-dent clinical risk factors for early complications in patients following interventional pulmonology procedures. Methods: In the period from December 2014 to December 2015, sufficient data of Peking University First Hospital Respiratory and Critical Care Medicine Department for analysis were identified in 218 subjects. Interventional pulmonology procedures were performed in all the patients. Early complications after the procedures were defined as newly respiratory failure, arrhythmia requiring treatment, severe hemoptysis, pneumothorax, pneumomediastinum, pulmonary edema, tracheoesophageal fistulae, bronchopleural fistulae, acute coronary syndrome, acute cerebrovascular accident, and death. Patient-related clinical risk factors were defined as coronary atherosclerotic heart disease, cerebral infarction, diabetes mellitus, cirrhosis, chronic kidney disease, arrhythmia, asthma, chronic obstructive pulmonary disease, hypertension, and previous interventional pulmonology treatment. The patient-related independent clinical risk factors which had close relations to the occurrence of early complications were analyzed by multivariate statistical analysis with Logistic regression.  Results: There were 56.4% male and 43.6% female subjects in this study. There were 10.6% current smokers, 26.6% former smokers, and 62.8% non-smokers. The overall early complication rate was 8.3%. In all the subjects groups, the patientrelated independent clinical risk factors for the early complication rate were coronary atherosclerotic heart disease （B=1.545， P=0.006， OR=4.686， 95% CI 1.568－14.006）, chronic obstructive pulmonary disease （B=1.037， P=0.049， OR=2.820， 95% CI 1.675－11.790）, and current smoking status （B=1.412， P=0.032， OR=4.139， 95% CI 1.134－15.109）; for the newly respiratory failure rates were coronary atherosclerotic heart disease （B=2.207， P=0.004， OR=9.087， 95% CI 2.028－40.714）, chronic obstructive pulmonary disease （B=1.646， P=0.048， OR=5.188， 95% CI 1.783－34.375）, and lesions involving three central airways （B=1.899， P=0.032， OR=6.680， 95% CI 1.182－37.740）. In the malignant group, the patientrelated independent clinical risk factor for the early complication rate was current smoking status （B=2.953， P=0.006， OR=19.161， 95% CI 2.360－155.572）. In the benign group, the patientrelated independent clinical risk factor for the early complication rate was only coronary atherosclerotic heart disease （B=1.976， P=0.022， OR=7.214， 95% CI 1.324－39.298）. Conclusion: Closer monitoring of patients with identified clinical risk factors is advisable prior and immediately after interventional pulmonology procedures. In order to avoid or minimize early complications, special attention should be directed toward patients who are current smokers, or patients with lesions involving three central airways, or with coronary atherosclerotic heart disease or chronic obstructive pulmonary disease.

Key words: Bronchoscopes, Postoperative complications, Risk factors