| Objective: To analyze the independent risk factors affecting the postoperative pulmonary complications(PPCs)of elderly patients and the 1,2 and3 year survival rates of lung cancer patients,to provide evidence for their prevention and treatment,and to analyze the perioperative treatment of elderly patients undergoing pulmonary surgery,compare and analyze its efficacy and safety,and guide clinical practice.Methods:(1)A total of 97 patients over 75 years old who were hospitalized in the Department of Thoracic surgery of the first affiliated Hospital of Guangxi Medical University from January 2017 to May 2020 were divided into PPCs group and non-PPCs group according to the occurrence of PPCs after operation.SPSS22.0 was used for statistical analysis.Univariate and multivariate Logistic regression analysis were used to analyze the independent risk factors affecting the occurrence of PPCs.(2)The perioperative treatment of lung surgery in elderly patients was counted and compared with the previous literature on lung surgery in all-age patients,and its efficacy and safety were analyzed.(3)The survival time of the elderly patients with lung cancer was followed up.The 1,2 and 3 year survival rates of the elderly patients with lung cancer were calculated by KaplanMeier method.Log-rank test single analysis and multivariate Cox regression analysis were used to analyze the independent risk factors affecting the 1,2 and 3year survival rates of the elderly patients with lung cancer.Results: 1.Univariate analysis showed that chronic pneumonia,albumin<35g/L,SI > 400,surgical resection range,VATS,LN dissection,intraoperative bleeding > 50 ml,operation time > 2.5h,ventilator use time > 3h,total drainage volume > 600 ml and chest tube indwelling time >4d were related to the occurrence of PPCs.The results of multivariate Logistic regression analysis showed that preoperative chronic pneumonia and heavy smoking(SI>400),intraoperative LN dissection and postoperative chest tube indwelling time>4 days were independent risk factors for PPCs in elderly patients after lung operation,while VATS operation was the protective factor.2.In this study,the average age of 97 elderly patients undergoing pulmonary surgery was77.52 ±2.48 years(75-88 years).The basic conditions before operation were hypertension in 39 cases(40.2%),coronary heart disease in 22 cases(22.7%),lacunar cerebral infarction in 24 cases(24.7%),diabetes in 8cases(8.2%),chronic pneumonia in 43 cases(44.3%)and smoking history in 29cases(29.9%).There were 20 cases(20.6%)of heavy smoking(SI > 400)and 29cases(29.9%)of obesity(BMI > 24).Perioperative treatment: VATS operation was performed in 72 cases(74.2%),perioperative blood transfusion was performed in 10 cases(10.3%),and lymph node dissection was performed in 77cases(79.3%).The average intraoperative blood loss was 88.03 ±112.67 ml and the average operation time was 2.47 ±1.35 h.The average placement time of thoracic drainage tube was 3.23 ±2.12 days,the average time of postoperative ventilator was 3.10 ±2.18 hours,the average total postoperative drainage volume was 511.15 ±363.40 ml,the average postoperative hospital stay was 7.42 ±5.65days(1 ±35 days),and the average total hospital stay was 13.03 ±6.17 days.Cheng Shaoyi,Liao Kaifu,Xie Jianjiang,Xu Jian,Jin Tianying reported that the average intraoperative blood loss was 132.53 ±15.97 ml,the average operation time was2.27 ±0.213 h,the average thoracic drainage tube placement time was 4.1±1.3days,the average postoperative ventilator time was 8.49 ±5.59 h,the average total postoperative drainage volume was 1054 ±547.8ml,and the average postoperative hospital stay was 8.8 ±1.4 days.The average total hospital stay was10.56 to 1.23 days.In this study,the incidence of PPCs in elderly patients after lung surgery was 28.9%,and the perioperative mortality rate was 2.06%.Perioperative mortality in elderly patients after lung surgery was 23.8%,29%,35%,25.5% and 33.64%,respectively.Mark reported that the perioperative mortality rate of elderly patients undergoing lung surgery was 4.5%.Mark reported that the incidence of postoperative PPCs in elderly patients after lung surgery was 23.8%,29%,35%,25.5% and 33.64%,respectively.Comparative analysis although the elderly patients in this study were more complicated with underlying diseases before lung surgery,but as long as the perioperative management and treatment were strengthened,the surgical efficacy was similar to that of other age groups,and the incidence of PPCs and perioperative mortality did not increase significantly.3.Univariate analysis showed that heavy smoking,tumor stage,albumin level,CEA level,NSE level,CYFRA21-1 level and SCCA level had significant effects on the 1,2-and 3 year survival rates of elderly patients with lung cancer,but the occurrence of PPCs had no significant effect on the 1,2 and 3 year survival rates of elderly patients with lung cancer.Multivariate Cox regression analysis showed that heavy smoking,hypoproteinemia,elevated CYFRA21-1 and tumor stage above IIB stage were independent risk factors for 1,2 and 3 year survival rates in elderly patients with lung cancer.Conclusions: 1.The elderly patients with chronic pneumonia,heavy smoking,LN dissection and chest tube indwelling time > 4 days have an increased risk of postoperative PPCs,and VATS operation is the protective factor.2.Lung surgery for elderly patients in this study is safe and reliable,and the curative effect is similar to that of other age groups by strengthening perioperative management and treatment.3.The short-term prognosis of elderly lung cancer patients with heavy smoking,hypoproteinemia,elevated CYFRA21-1 and tumor stage above IIB stage was worse. |
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