支气管镜下介入治疗早期并发症的独立危险因素

目的：分析支气管镜下介入治疗早期并发症发生的独立危险因素，探讨其对手术安全性的预测价值。方法： 回顾性分析北京大学第一医院呼吸和危重症医学科2014年12月至2015年12月接受支气管镜下介入治疗的218例次患者的临床资料，对可能与并发症发生相关的因素进行分析。结果： 本组患者男123例次（56.4%），女95例次 (43.6%)，无吸烟史者137例次（62.8%），已戒烟者58例次（26.6%），未戒烟者23例次（10.6%）。早期并发症发生率为8.3%（18/218），主要并发症包括新发呼吸衰竭、肺部感染、肺水肿、心律失常等。与总体并发症发生相关的独立危险因素有冠心病（B=1.545，P=0.006，OR=4.686，95%置信区间1.568~14.006）和慢性阻塞性肺病（B=1.037，P=0.049，OR=2.820，95%置信区间1.675~11.790）和未戒烟（B=1.412，P=0.032，OR=4.139，95%置信区间1.134~15.109），与新发呼吸衰竭发生相关的独立危险因素有冠心病（B=2.207，P=0.004，OR=9.087，95%置信区间2.028~40.714）、慢性阻塞性肺病（B=1.646，P=0.048，OR=5.188，95%置信区间1.783~34.375）和病变累及3个中心气道（B=1.899，P=0.032，OR=6.680，95%置信区间1.182~37.740）。恶性病变组早期并发症的独立危险因素仅有未戒烟（B=2.953，P=0.006，OR=19.161，95%置信区间2.360~155.572），良性病变组早期并发症的独立危险因素是冠心病（B=1.976，P=0.022，OR=7.214，95%置信区间1.324~39.298）。结论： 对于具有上述危险因素的患者应加强围介入操作期的监测，以减少和及时发现并发症的发生。

Patient-related independent clinical risk factors for early complications following interventional pulmonology procedures

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.