关键词: 胸腔镜肺叶切除术, 胸椎旁神经阻滞麻醉, 术中低体温, 术后肺部并发症

Abstract: Objective To explore the effect of intraoperative hypothermia on early pulmonary complications (PPCs) after thoracoscopic lobectomy under thoracic paravertebral nerve block (TPVB) anesthesia in elderly patients.Methods The clinical data of 126 elderly patients who underwent thoracoscopic lobectomy in our hospital from May 2022 to February 2025 were retrospectively collected.They were divided into the PPCs group and the non-PPCs group based on whether PPCs occurred during postoperative hospitalization.Logistic regression was used to analyze the relationship between intraoperative hypothermia and PPCs.The ROC curve was used to evaluate the predictive value of intraoperative hypothermia for PPCs.Results Among the 126 elderly patients who underwent thoracoscopic lobectomy included,21 cases developed PPCs within one week after the operation,with an incidence rate of 16.67%.The age,smoking history,diabetes,preoperative frailty,intraoperative hypothermia,duration of hypothermia,hypoalbuminemia and C-reactive protein (CRP) concentration in the PPCs group were all higher than those in the non-PPCS group (P<0.05).Univariate Logistic regression analysis showed that age,smoking history,diabetes,preoperative frailty,intraoperative hypothermia,duration of hypothermia,hypoalbuminemia,and CRP concentration were all associated with early PPCs after thoracoscopic lobectomy under TPVB anesthesia in elderly patients (P<0.05).Further multivariate Logistic regression analysis showed that age,preoperative frailty,intraoperative hypothermia,duration of hypothermia,hypoalbuminemia,and CRP concentration were independent risk factors for early PPCs after thoracoscopic lobectomy under TPVB anesthesia in elderly patients (P<0.05).The ROC curve showed that the AUC of intraoperative hypothermia and the duration of intraoperative hypothermia alone in predicting early PPCs after thoracoscopic lobectomy under TPVB anesthesia in elderly patients was 0.776 (95%CI:0.651-0.902) and 0.739 (95%CI:0.631-0.848),respectively,the combined AUC of the two was 0.920 (95%CI:0.857-0.983),which was greater than the AUC predicted separately for intraoperative hypothermia and the duration of intraoperative hypothermia (Z=2.064,P=0.039;Z=1.979,P=0.045).Conclusion Intraoperative hypothermia and its duration are important independent risk factors for early PPCs after thoracoscopic lobectomy under TPVB anesthesia in elderly patients.The combined detection of the two can improve the predictive efficacy for PPCs.

Key words: thoracoscopic lobectomy, thoracic paravertebral nerve block anesthesia, intraoperative hypothermia, postoperative pulmonary complications