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[1]成 鹏,席常青,赵 涛,等.慢性结核性脓胸术后肺复张影响因素分析[J].中华肺部疾病杂志,2024,(06):920-924.[doi:10.3877/cma.j.issn.1674-6902.2024.06.012
]
　Cheng Peng,Xi Changqing,Zhao Tao,et al.Analysis of influencing factors of pulmonary reexpansion after chronic tuberculous empyema operation[J].,2024,(06):920-924.[doi:10.3877/cma.j.issn.1674-6902.2024.06.012
]
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慢性结核性脓胸术后肺复张影响因素分析(PDF)

《中华肺部疾病杂志》[ISSN:1006-6977/CN:61-1281/TN]

卷:
期数:
2024年06期
页码:
920-924
栏目:
论著
出版日期:
2024-12-25

文章信息/Info

Title:
Analysis of influencing factors of pulmonary reexpansion after chronic tuberculous empyema operation
作者:
成 鹏; 席常青; 赵 涛; 李军孝; 陈其亮
710100 西安,陕西省结核病防治院结核外科
Author(s):
Cheng Peng;  Xi Changqing;  Zhao Tao;  Li Junxiao;  Chen Qiliang.
Author's institution: Department of Tuberculosis Surgery, Shaanxi Provincial Tuberculosis Prevention and Control Hospital, Xi'an 710100, China
关键词:
慢性结核性脓胸;  肺复张;  C反应蛋白;  AFB痰培养;  AFB胸腔积液培养
Keywords:
Chronic tuberculous empyema;  Pulmonary reexpansion;  C-reactive protein;  AFB sputum culture;  AFB pleural effusion culture
分类号:
R563
DOI:
10.3877/cma.j.issn.1674-6902.2024.06.012
摘要:
目的 分析慢性结核性脓胸术后肺康复效果及肺复张影响因素。方法 选取2019年1月至2023年9月我院治疗的73例手术治疗慢性结核性脓胸患者为对象,随访6个月,完全复张56例为对照组,部分复张及无复张17例为观察组。采用Logisic回归模型分析慢性结核性脓胸肺复张的影响因素。应用受试者工作特征(receiver operating characteristic, ROC)曲线预测慢性结核性脓胸肺复张情况。结果 观察组体质量指数(body mass index, BMI)(18.54±1.50)kg/m2低于对照组BMI(20.08±1.97)kg/m2,观察组有吸烟史8例(47.06%)、抗酸杆菌(acid-fast bacilli, AFB)痰培养阳性9例(52.94%)、AFB胸腔积液培养阳性4例(23.53%)、手术时间(4.16±0.49)h、C反应蛋白(40.21±2.24)g/L高于对照组吸烟史7例(12.50%)、AFB痰培养阳性7例(12.50%)、AFB胸腔积液培养阳性3例(5.36%)、手术时间(3.66±0.44)h、C反应蛋白(38.10±1.98)g/L(P<0.05); 多因素Logistic回归分析显示BMI(OR:0.063,95%CI:0.006～0.641)、吸烟史(OR:5.320,95%CI:1.148～24.645)、AFB痰培养(OR:10.856,95%CI:1.593～73.987)、AFB胸腔积液培养(OR:2.568,95%CI:1.031～6.397)、C反应蛋白(OR:4.704,95%CI:1.274～17.359)、手术时间(OR:9.895,95%CI:1.457～67.191)是慢性结核性脓胸术后肺复张不良的影响因素(P<0.05); ROC曲线显示,BMI、吸烟史、AFB痰培养、AFB胸腔积液培养阳性、手术时间及C反应蛋白诊断慢性结核性脓胸术后肺复张不良的曲线下面积(area under curve, AUC)为0.739、0.673、0.702、0.591、0.765、0.789。结论 BMI、吸烟史、AFB痰培养、AFB胸腔积液培养阳性、手术时间及C反应蛋白是慢性结核性脓胸术后肺复张不良的影响因素。
Abstract:
Objective To analyze the influencing factors of pulmonary reexpansion after chronic tuberculous empyema operation. Methods A total of 73 patients with chronic tuberculous empyema treated in our hospital from January 2019 to September 2023 were selected as the subjects, followed up for 6 months, 56 cases with complete pulmonary reexpansion were the control group, and 17 cases with partial pulmonary reexpansion and no pulmonary reexpansion were the observation group. By comparing the two groups of general data, Logisic regression model was used to analyze the influencing factors of pulmonary reexpansion in chronic tuberculous empyema. ROC curve was used to predict pulmonary reexpansion of chronic tuberculous empyema. Results The body mass index(BMI)of the observation group(18.54±1.50)kg/m2 was lower than that of the control group(20.08±1.97)kg/m2. In the observation group, 8 patients(47.06%)had a history of smoking and acid-fast bacilli. Sputum culture positive 9 cases(52.94%), AFB pleural effusion culture positive 4 cases(23.53%), operation time(4.16±0.49)h, C-reactive protein(40.21±2.24)g/L were higher than the control group in 7 cases(12.50%), AFB sputum culture positive 7 cases(12.50%), AFB Pleural effusion culture was positive in 3 cases(5.36%), operative time(3.66±0.44)h, C-reactive protein(38.10±1.98)g/L(P<0.05); Multivariate Logistic regression analysis showed BMI(OR: 0.063, 95%CI: 0.006-0.641), smoking history(OR: 5.320, 95%CI: 1.148-24.645), AFB sputum culture(OR: 10.856, 95%CI: 1.593-73.987), AFB pleural effusion culture(OR: 2.568, 95%CI: 1.031-6.397), C-reactive protein(OR: 4.704, 95%CI: 1.274-17.359), operation time(OR: 9.895, 95%CI: 1.457-67.191)was the influential factor of poor pulmonary reexpansion after chronic tuberculous empyema operation(P<0.05). ROC curve showed that BMI, smoking history, positive proportion of AFB sputum culture, AFB pleural effusion culture, operation time and C-reactive protein in the diagnosis of chronic tuberculous chest abscess postoperative poor lung reexpansion area under curve, AUC was 0.739, 0.673, 0.702, 0.591, 0.765, 0.789. Conclusion BMI, smoking history, positive proportion of AFB sputum culture, AFB pleural effusion culture, operation time and C-reactive protein are the influential factors of lung reexpansion after chronic tuberculous empyema operation.

参考文献/References:

1 任成山, 林 辉, 杨仕明. 结核病的流行特征与耐多药的窘迫及其策略[J/CD]. 中华肺部疾病杂志(电子版), 2019, 12(3): 269-274.
2 蒋钰辉, 戴希勇, 申 磊. 单孔胸腔镜与开胸纤维板剥脱术治疗慢性结核性脓胸的比较[J]. 中国微创外科杂志, 2023, 23(2): 98-102.
3 周逸鸣, 洪 旗, 尹桂东, 等. 单孔胸腔镜全纤维板剥脱术治疗Ⅲ期结核性脓胸158例临床分析[J]. 中华外科杂志, 2022, 60(1): 90-94.
4 Dantis K, Kumar Dewan R. Surgical outcomes and the factors affecting lung expansion following open window thoracostomy in chronic tuberculous empyema with destroyed lung[J]. Asian Cardiovasc Thorac Ann, 2022, 30(6): 696-705.
5 陈 玮, 方 懿, 李 贵, 等. 超声引导下胸椎旁神经阻滞联合全身麻醉在结核性脓胸患者胸腔镜手术中的应用效果[J]. 广西医学, 2022, 44(1): 19-22.
6 刘勇恩, 马幸生. 彻底性纤维板剥脱治疗慢性机化性脓胸临床疗效[J]. 四川医学, 2022, 43(6): 598-602.
7 Zeng X, Yue W, Ye S, et al. Evaluation of thoracic surgery as a treatment approach in patients with rifampin-resistant chronic tuberculous empyema[J]. J Bras Pneumol, 2022, 48(4): e20220074.
8 Zhu P, Xu X, Ye B, et al. A nomogram to predict residual cavity formation after thoracoscopic decortication in chronic tuberculous empyema[J]. Interact Cardiovasc Thorac Surg, 2022, 34(5): 760-767.
9 王继文, 庄 猛, 单蓓莹, 等. 肺复张联合个体化PEEP策略对腹腔镜手术老年患者术后肺不张程度的影响[J]. 中华麻醉学杂志, 2024, 44(2): 150-154.
10 周为鸿. 结核诊断金标准探讨[J]. 实用诊断与治疗杂志, 2006, 20(10): 741-742.
11 Sikander N, Ahmad T, Mazcuri M, et al. Role of anti-tuberculous treatment in the outcome of decortication for chronic tuberculous empyema[J]. Cureus, 2021, 13(1): e12583.
12 McNally E, Ross C, Gleeson LE. The tuberculous pleural effusion[J]. Breathe(Sheff), 2023, 19(4): 230143.
13 彭海军, 段小亮, 李义帅, 等. 加速康复外科在结核性脓胸电视胸腔镜手术围术期的应用[J]. 局解手术学杂志, 2023, 32(6): 532-536.
14 Ren HQ, Zhao Q, Jiang J, et al. Accidental detection of tuberculous empyema at health check-up[J]. Clin Lab, 2024, 70(1): doi: 10.7754/Clin.Lab.2023.230727.
15 张光照, 杜佳辉, 袁五营. 基于加速康复外科理念的改良单切口治疗结核性外穿性脓胸的临床疗效观察[J]. 实用医院临床杂志, 2022, 19(6): 88-91.
16 降初拉尔布, 肖航宇, 徐 孟, 等. 电视胸腔镜辅助胸膜纤维板剥脱术治疗结核性脓胸患者围手术指标、心肺功能及并发症的影响[J]. 实用医院临床杂志, 2022, 19(5): 150-153.
17 蒋钰辉, 申 磊, 刘奇斌, 等. 单孔胸腔镜胸膜纤维板剥脱术在耐药结核性脓胸治疗中的应用[J]. 中华外科杂志, 2023, 61(2): 156-161.
18 Soundappan V, Nagarajan K, Sunitha VC. Tuberculous subdural empyema mimicking chronic subdural hematoma[J]. J Neurosci Rural Pract, 2023, 14(3): 554-555.
19 Hirano Yuki, Kaneko Hidehiro, Konishi Takaaki, et al. Impact of body mass index on major complications, multiple complications, in-hospital mortality, and failure to rescue after esophagectomy for esophageal cancer: A nationwide inpatient database study in Japan[J]. Ann Surg, 2023, 277(4): e785-e792.
20 Anderson Michaela R, Cantu Ed, Shashaty Michael, et al. Body mass index and cause-specific mortality after lung transplantation in the united states[J]. Ann Am Thorac Soc, 2023, 20(6): 825-833.
21 王 芳, 赵 娟. 营养支持结合肺功能训练对老年结核性胸腔积液患者血清营养学指标、肺功能及免疫功能的影响[J]. 医学理论与实践, 2021, 34(2): 342-344.
22 丁晓燕, 陈远翔, 吴丽敏, 等. 胸腔镜心脏手术后复张性肺水肿发生危险因素分析[J]. 中国现代医生, 2022, 60(1): 103-106.
23 张慧民, 许光辉, 陈 华, 等. 吸烟对肺结核患者肺功能的影响及其针对性护理措施[J]. 中国实用医药, 2017, 12(12): 163-164.
24 王 贞, 王 军, 孙 芳, 等. 纤维支气管镜介入时机对伴气道内黏液栓塞肺炎支原体肺炎患儿肺复张的影响[J]. 热带医学杂志, 2022, 22(3): 387-391, 封4.
25 刘艳华, 王 若, 安红娟, 等. FCGR1B基因转录水平检测对活动性结核病诊断的价值研究[J]. 中华结核和呼吸杂志, 2022, 45(4): 373-378.
26 周佳宏. 胸科手术后肺部并发症的研究进展[J]. 中国微创外科杂志, 2023, 23(6): 469-474.
27 金天英, 徐珠慧, 邬东强. 胸腔镜手术治疗老年肺结节患者术后肺部并发症的影响因素及对远期预后的影响[J]. 江苏医药, 2021, 47(1): 48-51.
28 裴帅杰, 谢克亮. 围术期肺复张策略的研究进展[J]. 中华麻醉学杂志, 2023, 43(11): 1405-1408.
29 邓玉辉. 超声引导下肺复张在老年人腹腔镜下结直肠癌根治术围麻醉期的应用[J]. 黑龙江医药, 2024, 37(3): 538-541.
30 吴宇杰, 沈 昊, 钟叶平, 等. CRP, ESR结合痰培养诊断下呼吸道感染的效果观察[J]. 西藏医药, 2023, 44(6): 29-30.
31 王 倩, 戎燕筱, 孙雪培, 等. 氨溴索联合抗结核治疗慢性阻塞性肺疾病合并肺结核的临床疗效及安全性分析[J]. 实用医院临床杂志, 2024, 21(2): 66-69.

备注/Memo

备注/Memo:
通信作者: 席常青, Email: 13353599046@163.com
更新日期/Last Update: 2024-12-25