| 摘要: |
| 目的 探讨膈肌功能与肺切除术后肺部并发症和近期预后的关系，分析导致膈肌功能障碍的危险因素。方法 选取我院胸外科行单侧肺切除术的患者90例，分别于术前和术后24 h、48 h、72 h四个时间运用床旁超声监测患者双侧膈肌移动度（DE）。根据术后膈肌移动度分为膈肌功能障碍组（DD组）和膈肌功能正常组（ND组），比较两组患者术后肺部并发症发生情况及近期预后的差异，Logistic回归分析导致膈肌功能障碍的危险因素。结果 DD组术后肺部并发症（肺复张不全、术后残腔、胸腔积液、肺部感染）发生率均高于ND组，差异均有统计学意义（均P＜0.05）；DD组近期预后（肺完全复张时间、术后带管时间）均较ND组差，差异均有统计学意义（均P＜0.05）。两组患者术侧膈肌移动度均呈先下降后回升的趋势，健侧膈肌移动度术后48 h保持不变，从术后72 h开始代偿性增加。Logistic回归分析表明吸烟史、肺叶切除均为术后膈肌功能障碍的危险因素（均P＜0.05）。结论 肺切除术后膈肌功能障碍导致肺部并发症发生率增高，不利于近期预后；床旁超声可用于评估围术期膈肌移动度，早期发现膈肌功能不全，为临床制定对应策略提供帮助。 |
| 关键词: 超声 膈肌移动度 肺切除术 预后 |
| DOI： |
| 投稿时间：2021-01-09修订日期：2021-02-25 |
| 基金项目:医院学术带头人储备人才基金项目（xkts060） |
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| Study on the relationship between ultrasound measurement of diaphragmatic excursion and pulmonary complications and short-term prognosis after pneumonectomy |
| yuehong,Wang Xiaowen,贺,Li Linjun,Zhang Yong,Chen Dan,Wu Qingchen |
| (The First Affiliated Hospital of Chongqing Medical University) |
| Abstract: |
| Objective To explore the relationship between diaphragm function and postoperative pulmonary complications and short-term prognosis，analyze the risk factors leading to diaphragm dysfunction, so as to guide the formulation of perioperative strategies to promote rehabilitation for post-pneumonectomy patients.Methods Ninety patients of unilateral pneumonectomy in thoracic surgery of our hospital were collected sequentially. Diaphragmatic excursion was measured sequentially for each patient before and 24 hours，48 hours，and 72 hours after operation by beside ultrasound. According to the postoperative diaphragmatic excursion，the patients were divided into two groups：diaphragm dysfunction group（DD） and Normal diaphragmatic functin group（ND）. The differences in the incidence of postoperative pulmonary complications and short-term prognosis between the two groups were compared. Logistic regression was used to analysis risk factors which led to diaphragm dysfunction.Results The incidence of postoperative pulmonary complications（atelectasis，postoperative residual cavity，pleural effusion，and lung infection） in the DD group was higher than that in the ND group，and the differences were statistically significant（all p＜0.05）；The short-term prognosis of the DD group （the time to complete lung recruitment and post-operative catheterization） was worse than that of the ND group，the difference was statistically significant（all p＜0.05）. In both grops, diaphragmatic excursion first decreased and then increased on the operative side，while it remained unchanged on the opposite side at 48 hours after operation and increased compensatively from 72 hours after operation；Logistic regression analysis showed that smoking history and lobectomy were risk factors for postoperative diaphragmatic dysfunction（P＜0.05）.Conclusion Diaphragmatic dysfunction after pneumonectomy leads to higher incidence of pulmonary complications， which is not conducive to short-term prognosis. Bedside ultrasound can be used to evaluate the diaphragmatic excursion during peri-operative period，and early detection of diaphragm dysfunction can provide help for clinical development of corresponding strategies. |
| Key words: Ultrasound Diaphragmatic excursion Pneumonectomy Prognosis |
