The Predictive Effect Of Fractional Exhaled Nitric Oxide Combined With Multiple Factors On Postoperative Pulmonary Complications In Elderly Patients After Thoracic Surgery

Objective The purpose of this paper was to investigate the predictive effect of preoperative fractional exhaled nitric oxide(Fe NO)combined with multiple risk factors on postoperative pulmonary complications(PPCs)in elderly patients after thoracic surgery with general anesthesia and to provide evidence for clinical prevention and identification.Methods92 eligible elderly patients undergoing general anesthesia for thoracic surgery admitted to the First Affiliated Hospital of Jinzhou Medical University from February 2018 to October 2019 were selected as the research subjects.According to the occurrence of PPCs in each patient,92 patients were divided into PPCs group(n=16)and non-PPCs group(n=76).The Fe NO value of 10 min before operation was measured by Nano Coulomb Nitric Oxide analyzer.Preoperative baseline characteristics and surgical data were compared between the two groups,and data analysis was performed using SPSS 20.0 statistical software.Single factor analysis and logistic regression were used to screen independent risk factors for PPCs in elderly patients undergoing thoracic surgery.Receiver operating characteristic(ROC)curves were used to analyze the predictive ability of the comprehensive model.Results A total of 92 patients were included in this study.According to the incidence of PPCs in each patient,they were divided into PPCs group(n=16)and non-PPCs group(n=76).The PPCs group refers to patients who had at least one postoperative pulmonary complication within seven days after surgery,while the non-PPCs group included patients who did not have postoperative pulmonary complications within seven days after surgery.The univariate data analysis showed that the PPCs group was older than the non-PPCs group.The proportion of patients with a history of smoking and chronic obstructive pulmonary disease(COPD)was higher than the non-PPCs group.The proportion of patients undergoing endoscopic surgery was lower than the non-PPCs group.The difference between the groups was statistically significant(P<0.05).The distribution of the Fe NO value of 10 min before operation in the PPCs group was different from the non-PPCs group.The median and inter-quartile range of Fe NO in the PPCs group before surgery was 30.5(25-43.5)ppb,and the non-PPCs group was 19(14.25-25)ppb.The PPCs group was higher overall,and the differences between groups were statistically significant(P<0.05).Logistic regression analysis showed that endoscopic surgery,age,history of COPD,and the Fe NO value of 10 min before operation were independent factors of PPCs in elderly patients undergoing thoracic surgery(P<0.05).The analysis of the receiver operating characteristic curve showed that when the Fe NO value of 10 min before operation predicted independently the area under the curve was 0.821,and the area under the curve for the three factors combination of age,endoscopic surgery,and history of COPD was 0.735.The highest one among the three groups was the combination of Fe NO,age,endoscopic surgery method,and history of COPD,which area under the curve was 0.939,the difference is statistically significant.Conclusions Preoperative 10 min Fe NO combined with age,endoscopic surgery and COPD history can predict the occurrence of PPCs in elderly patients who undergoing thoracic surgery with general anesthesia which provides a basic method for clinical high-risk identification in postoperative pulmonary complications.