关键词: 电视胸腔镜, 手术, 老年, 食管癌, 心血管不良反应, 影响因素

Abstract:

Background and purpose: The establishment of artificial pneumothorax during video-assisted thoracoscopic surgery may affect the intrathoracic pressure, cause the obstruction of superior vena cava reflux, and lead to the increased risk of adverse cardiovascular events during hospitalization. However, elderly patients with esophageal cancer are more likely to have adverse cardiovascular events during the perioperative period due to the significant decline in functional status, which seriously affects the rehabilitation process. This study aimed to investigate the influencing factors of cardiovascular adverse events risk in elderly patients with esophageal cancer undergoing video-assisted thoracoscopic surgery and construct nomograph model to guide the formulation of clinical intervention plan. Methods: Five hundred and forty-six elderly patients with esophageal cancer undergoing video-assisted thoracoscopic surgery who were treated in The First Hospital of Danjiangkou City were retrospectively chosen in the period from January 2015 to October 2020. All patients were grouped according to the occurrence of cardiovascular adverse events in perioperative period, the related clinical data were analyzed, and the independent influencing factors of cardiovascular adverse events were evaluated by logistic regression model. Based on the above factors, the nomogram prediction model was constructed and receiver operating characteristic (ROC) curve was drawn to evaluate the prediction efficiency of nomogram model. Results: Eighty-four cases (15.38%) had perioperative cardiovascular adverse events in all 546 patients. Univariate analysis showed that American Society of Anesthesiologists (ASA) grade, the number of clinical risk factors, the level of hemodynamic changes, the level of airway pressure and the level of central venous pressure (CVP) were all related to the occurrence of cardiovascular adverse events (P<0.05). Multivariate analysis showed that ASA classification, the number of clinical risk factors, the level of hemodynamic changes and CVP were the independent influencing factors of cardiovascular adverse events (P<0.05). The nomogram prediction model was constructed according to the independent influencing factors of cardiovascular adverse event risk confirmed by multivariate analysis. The area under curve (AUC) of above nomogram model for predicting the risk of cardiovascular adverse events was 0.88 (95% CI: 0.81-0.97), and the sensitivity and specificity were 87.26% and 91.60% respectively. Conclusion: The incidence of cardiovascular adverse events in elderly patients with esophageal cancer undergoing video-assisted thoracoscopic surgery is independently related to many factors, of which ASA grade >Ⅲ, number of clinical risk factors >3, hemodynamic change level ≥30%, airway pressure level >30 cm H₂O and CVP level >20 cm H₂O have higher risk. The nomogram model based on the above factors has good prediction efficiency and may guide the formulation of clinical intervention programs.

Key words: Video-assisted thoracoscopic, Surgery, Elderly, Esophageal cancer, Cardiovascular adverse events, Influencing factors