实用老年医学

实用老年医学 ›› 2025, Vol. 39 ›› Issue (10): 1014-1018.doi: 10.3969/j.issn.1003-9198.2025.10.009

• 临床研究 • 上一篇    下一篇

老年胸腔镜下肺部分切除术病人胸椎旁神经阻滞、阿片类药物与术后肺部并发症的风险:交互效应与中介效应分析

曹青, 张扬, 程浩, 阮姗, 桂波, 许斯洋   

  1. 210024 江苏省南京市,南京医科大学附属老年医院麻醉疼痛科(曹青,程浩,阮姗,许斯洋,桂波);
    210029 江苏省南京市,南京医科大学第一附属医院麻醉与围术期医学科(张扬)
  • 收稿日期:2025-02-07 发布日期:2025-10-28
  • 通讯作者: 许斯洋,Email: xsyjy2020@126.com

Association of thoracic paravertebral block and opioid consumption with risk of postoperative pulmonary complications in elderly patients undergoing thoracoscopic partial lung resection: interaction effect and mediation effect analysis

CAO Qing, ZHANG Yang, CHENG Hao, RUAN Shan, GUI Bo, XU Siyang   

  1. Department of Anesthesiology and Pain, Geriatric Hospital of Nanjing Medical University, Nanjing 210024, China(CAO Qing, CHENG Hao, RUAN Shan, XU Siyang, GUI Bo);
    Department of Anesthesiology and Perioperative Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China(ZHANG yang)
  • Received:2025-02-07 Published:2025-10-28
  • Contact: XU Siyang, Email:xsyjy2020@126.com

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摘要： 目的 探讨老年胸腔镜下肺部分切除术(TPPR)病人胸椎旁神经阻滞(TPVB)、阿片类药物用量[以口服吗啡当量(OME)计算]与术后肺部并发症(PPCs)的交互效应和中介效应。方法 回顾性分析南京医科大学第一附属医院816例≥65岁接受TPPR的病人资料,根据是否发生PPCs分为PPCs组与非PPCs组。采用多因素logistic回归分析TPVB与OME对老年TPPR病人PPCs的影响,并分析TPVB与OME的相乘交互效应和中介效应。结果 PPCs发生率为40.4%。多因素logistic回归分析显示,OME是老年TPPR病人PPCs发生的危险因素(P<0.001),TPVB是其保护因素(P<0.001)。二者相乘交互效应显示,未接受TPVB且使用高剂量阿片类药物的病人PPCs风险增加4.6倍(OR =4.556,95%CI:2.248~9.234),即使接受TPVB,联合高剂量阿片类药物时,PPCs风险仍增加2.1倍(OR =2.098,95%CI:1.126~3.910)。此外,阿片类药物介导了TPVB与PPCs之间的中介效应(Z=-2.124,P=0.034)。结论 TPVB与阿片类药物对老年TPPR病人PPCs的发生具有显著的交互效应和中介效应。在临床实践中, 优化围手术期镇痛,积极实施TPVB,合理控制阿片类药物用量,对降低老年TPPR病人PPCs 的风险至关重要。

关键词: 胸椎旁神经阻滞, 阿片类药物, 胸腔镜肺部分切除术, 老年人, 术后肺部并发症

Abstract: Objective To investigate the interaction and mediating effects of thoracic paravertebral block (TPVB) and opioid consumption(oral morphine equivalent,OME) on postoperative pulmonary complications (PPCs) in the elderly patients undergoing thoracoscopic partial pulmonary resection (TPPR). Methods The data of 816 elderly patients aged ≥65 years old who underwent TPPR at the First Affiliated Hospital of Nanjing Medical University were analyzed retrospectively. The patients were divided into PPCs group and non-PPCs group according to whether they presented with PPCs. Multivariate logistic regression was used to evaluate the independent effect of TPVB and OME on PPCs, and the interaction effect and mediation effect between TPVB and OME were analyzed. Results The incidence rate of PPCs was 40.4%. Multivariate logistic regression analysis showed that OME was a risk factor for PPCs, while TPVB was a protective factor (P<0.001). The multiplicative interaction between these two factors showed that the patients who did not receive TPVB and were administered high-dose opioids had a 4.6-fold increased risk of developing PPCs (OR=4.556, 95% CI: 2.248-9.234). Even with the use of TPVB combined with high doses of opioids, the risk of PPCs was 2.1 times higher (OR=2.098, 95% CI: 1.126-3.910). Moreover, opioid consumption was found to mediate the relationship between TPVB and PPCs (Z=-2.124, P=0.034). Conclusions TPVB and opioid consumption exert significant interactive and mediating effects on the development of PPCs in the elderly patients undergoing TPPR. In clinical practice, optimizing perioperative analgesia, actively applying TPVB, and appropriately regulating opioid administration are crucial to reduce the risk of PPCs in the elderly patients with TPPR.

Key words: thoracic paravertebral block, opioids, thoracoscopic partial pulmonary resection, aged, postoperative pulmonary complications

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