本文選題：Logistic分析　切入點：胸腔鏡手術(shù)　出處：《大連醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:低氧血癥是胸腔鏡術(shù)中單肺通氣時所發(fā)生的嚴(yán)重并發(fā)癥,而大多數(shù)以低氧血癥為研究中心的相關(guān)研究則以單因素分析為主,多因素分析相比較單因素獨立分析而言,考慮了每個因素之間的內(nèi)在關(guān)聯(lián)和相互作用,結(jié)果更為可靠。本研究通過收取大連醫(yī)科大學(xué)附屬第一醫(yī)院病歷資料利用回顧性研究的方法,運用logistic逐步回歸法對影響胸腔鏡術(shù)中低氧血癥發(fā)生的相關(guān)因素進行分析,探討胸腔鏡術(shù)中單肺通氣時與低氧血癥有關(guān)的因素,為預(yù)測術(shù)前低氧血癥和防治術(shù)中低氧血癥提供可靠參考從而提高胸腔鏡手術(shù)和麻醉的安全性。方法:本研究采用回顧性分析的方法對收取的大連醫(yī)科大學(xué)附屬第一醫(yī)院2016年8月至2016年12月期間,接受胸腔鏡手術(shù)患者的臨床病歷資料551例進行回顧性研究,通過參考相關(guān)資料文獻收集患者的臨床病歷資料,收集患者的一般資料情況(性別、年齡),既往史(是否規(guī)律服用血管活性藥物,肺部疾病病史),術(shù)前情況(紅細胞水平、白蛋白水平、肺功能、腎功能、ASA分級、心臟彩超),以及術(shù)中情況(手術(shù)種類、手術(shù)體位、雙腔支氣管導(dǎo)管類型、麻醉方式、入室平均動脈壓、開始單肺通氣時距手術(shù)開始時間)。對影響胸腔鏡術(shù)中低氧血癥發(fā)生的相關(guān)因素進行單因素分析,進而篩選出P0.1的變量進行多因素logistic逐步回歸分析,探討胸腔鏡術(shù)中單肺通氣時與低氧血癥相關(guān)的因素,為預(yù)測術(shù)前低氧血癥和防治術(shù)中低氧血癥提供可靠參考從而提高胸腔鏡手術(shù)和麻醉的安全性。結(jié)果:在本次研究共納入的551例病例中發(fā)生低氧血癥的發(fā)生率為8.9%(共49例)。在單因素分析中,有6個因素與胸腔鏡手術(shù)中單肺通氣中發(fā)生低氧血癥相關(guān),分別是:ASA(P=0.002,r=0.129),開始單肺通氣時距手術(shù)開始時間(P=0.071,r=-0.077),手術(shù)種類(P=0.032,r=0.091),肺功能(P=0.034,r=-0.090),心臟彩超(P=0.024,r=0.096),術(shù)中是否使用血管活性藥物(P=0.037,r=0.089)。通過多因素logistic逐步回歸分析共有5個具有統(tǒng)計學(xué)意義(P0.05)的因素被選入回歸方程。其中危險因素有3個,分別是心臟彩超(0R=2.405,P=0.018),ASA分級(OR=2.378,P=0.008),手術(shù)種類(0R=1.389,P=0.021),保護因素有 2 個,分別是肺功能(OR=O.502,P=0.047),開始單肺通氣時距手術(shù)開始時間(OR=0.594,P=0.024)。結(jié)論:1.ASA分級,手術(shù)種類,心臟彩超為胸腔鏡術(shù)中發(fā)生低氧血癥發(fā)生的危險因素。隨著ASA分級的升高,手術(shù)種類的變化,心臟彩超的異常,胸腔鏡術(shù)中低氧血癥的發(fā)生率將升高。2.肺功能和開始單肺通氣時距手術(shù)開始時間,為胸腔鏡術(shù)中低氧血癥發(fā)生的保護因素。隨著肺功能的異常和開始單肺通氣時距手術(shù)開始時間的增加,胸腔鏡術(shù)中低氧血癥的發(fā)生率將下降。
[Abstract]:Objective: hypoxemia is a serious complication of thoracoscopy in one lung ventilation occurred, and most of the Research Center for study of hypoxemia in univariate analysis, multivariate analysis comparing independent single factor analysis, correlation and interaction between each factor is taken into account, the result is more reliable this study. Through a retrospective study method using the medical records of the First Affiliated Hospital of Dalian Medical University, the use of logistic related factors on the impact of hypoxia in thoracoscopy in the regression analysis, to explore the factors associated with hypoxemia for single lung ventilation in thoracoscopy, provide a reliable reference for preoperative prediction of hypoxic hypoxia prevention and treatment of postoperative hypoxemia and in thoracoscopic surgery and to improve the safety of anesthesia. Methods: This study used a retrospective analysis of the medical charge in Dalian Department of the First Affiliated Hospital from August 2016 to December 2016 period, patients received thoracoscopic surgery the clinical data of 551 cases were reviewed by clinical data refer to the relevant literature were collected, the general data were collected (gender, age), history (whether the regular use of vasoactive drugs, lung disease), preoperative (red blood cell levels, albumin level, pulmonary function, renal function, ASA classification, cardiac ultrasound), and intraoperative (type of surgery, surgical position, double lumen tube type, anesthesia, a mean arterial pressure during one lung ventilation, beginning from the operation start time of single factor). Analysis of the influencing factors of hypoxia in thoracoscopy of hyponatremia, and then screened P0.1 variables were analyzed by logistic regression analysis of single lung ventilation in thoracoscopy with low The factors related to hypoxemia, to provide reliable reference of preoperative prediction and prevention and treatment of postoperative hypoxemia hypoxia in thoracoscopic surgery and to improve the safety of anesthesia. Results: hypoxemia occurred in 551 cases in this study included the incidence rate was 8.9% (49 cases). In univariate analysis, there are 6 factors and one lung ventilation in thoracoscopic surgery in hypoxemia, respectively is: ASA (P=0.002, r=0.129), start one lung ventilation from the operation start time (P=0.071, r=-0.077), operation type (P=0.032, r=0.091), pulmonary function (P=0.034, r=-0.090), echocardiography (P=0.024, r=0.096), whether the use of intraoperative vasoactive drugs (P=0.037, r=0.089). By multivariate stepwise logistic regression analysis, there were 5 statistically significant factors (P0.05) were selected in the regression equation. The risk factors were 3, echocardiography (0R=2.405, P=0.018), ASA classification (OR=2.378, P=0.008), operation type (0R=1.389, P=0.021), there are 2 protective factors were pulmonary function (OR=O.502, P=0.047), start one lung ventilation from the operation start time (OR=0.594, P=0.024). Conclusion: 1.ASA classification, type of surgery, heart disease are the risk factors of hypoxemia occurred in thoracoscopy. With the increase of ASA grading, change the type of surgery, abnormal echocardiography, thoracoscopy in the incidence of hypoxemia will increase.2. pulmonary function and start one lung ventilation from the operation start time, protective factors for thoracic surgery hypoxemia. With the exception and began to increase from the operation start time of single lung ventilation pulmonary function, the incidence of thoracoscopy in hypoxemia will decrease.

【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R614
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本文編號：1633417