关键词: 肺肿瘤, 老年人, 胸腔镜检查, 肺切除术, 心律失常，心性

Abstract:

Objective To investigate risk factors of arrhythmia in elderly patients with early lung cancer after thoracoscopic pulmonary resection to construct a prediction model. Methods Two hundreds and twenty elderly patients with early lung cancer after thoracoscopic pulmonary resection were retrospectively chosen in the period from January 2017 to January 2023 in Guang'an People's Hospital of Sichuan Province. The occurrence of arrhythmia was calculated， and the clinical data of patients with arrhythmia and those without arrhythmia were compared. Logistic regression was employeed to analyze the independent influencing factors of arrhythmia in elderly patients with early lung cancer after thoracoscopic pneumonectomy. Receiver operating characteristic （ROC） curve was used to evaluate the diagnostic performance of regression model on arrhythmia after thoracoscopic pneumonectomy in elderly patients with early lung cancer. Results Forty-one of 220 （18.64%） elderly patients with early lung cancer treated by thoracoscopic pneumonectomy had arrhythmia. There were statistically significant differences between patients with arrhythmia and patients without arrhythmia in age （χ²=17.76， P<0.001）， combined with essential hypertension （χ²=21.06， P<0.001）， forced expiratory volume in one second as a percentage of predicted value （FEV₁%） （χ²=17.88， P<0.001）， left atrium anterior-and-posterior diameter （χ²=37.82， P<0.001）， operation type （χ²=27.09， P<0.001） and postoperative constipation （χ²=18.25， P<0.001）. The results of multivariate analysis showed that age>75 years old （OR=22.17， 95%CI： 3.78-130.11， P=0.001）， combined with essential hypertension （OR=26.55， 95%CI： 3.99-176.95， P=0.001）， FEV₁%≤70% （OR=6.20， 95%CI： 1.37-28.11， P=0.018）， left atrium anterior-and-posterior diameter>40 mm （OR=10.84， 95%CI： 2.24-52.45， P=0.003）， thoracoscopic lobectomy （OR=7.07， 95%CI： 1.62-30.80， P=0.009）， and postoperative constipation （OR=79.97， 95%CI： 11.87-538.83， P<0.001） were all independent risk factors for arrhythmia after thoracoscopic pulmonary resection in elderly patients with early lung cancer. A prediction model was established for statistically significant indicators in multivariate analysis， ln（P/1-P）=-7.89+3.10×age+3.28×combined with essential hypertension+1.82×FEV₁%+2.38×left atrium anterior-and-posterior diameter+1.96×operation type+4.38×postoperative constipation （P was the prediction probability of P value in regression model）. ROC curve analysis showed that the area under the curve （AUC） of predict arrhythmia after thoracoscopic pulmonary resection in elderly patients with early lung cancer were 0.64， 0.71， 0.68， 0.74， 0.76， 0.87 and 0.98， respectively. The Yoden index was 27.29%， 42.28%， 34.92%， 47.42%， 73.63%， 50.97% and 91.97%， respectively. Conclusion Age>75 years old， combined with essential hypertension， FEV₁%≤70%， left atrium anterior-and-posterior diameter>40 mm， thoracoscopic lobectomy and postoperative constipation are all independent risk factors for arrhythmia after thoracoscopic pulmonary resection in elderly patients with early lung cancer. Nomogram model based on the above risk factors has high efficacy in predicting arrhythmia occurance after thoracoscopic pulmonary resection.

Key words: Lung neoplasms, Aged, Thoracoscopy, Pneumonectomy, Arrhythmias， cardiac